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RK61  K16  Care  of  the  mouth  an 


RECAP 


CARE  OF  THE  MOUTH 
\ND  TEETH 


KAUFFMANN 


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REBMAN  NEW  YORK 


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Columbia  ^nibcrfiitp 
in  tfjc  Citp  o!  J^eto  gorfe 

College  of  ^ijpgicians  anb  ^urgeong 


l^eference  Itibrarp 


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CARE  OF  THE 
MOUTH  AND  TEETH 

A  PRIMER  OF  ORAL  HYGIENE 


BY 


JOSEPH  HERBERT  KAUFFMANN,  D.D.S. 

ATTENDING    DENTAL    SURGEON    TO    THE    BRONX    HOSPITAL    DISPENSARY    AND    ASSISTANT 
DENTAL  CLINICIAN  TO  THE  VANDERBILT  CLINIC,  NEW  YORK  CITY 


NEW   YORK 

REBMAN    COMPANY 

141    WEST   36th   street 


COPYMGHT,    1916,    BY 

REBMAN    COMPANY 
New  York 


PBIXTED  IN  AMEBICA 


Dedicated  to 
MY   PARENTS 

AS  AN   ITEM   OP  APPRECIATION 


PREFACE 

Perhaps  it  is  superfluous  to  state  that  this 
brief  volume  aims  at  nothing  else  than  the  grasp- 
ing of  the  fundamental  idea  of  the  value  of  oral 
hygiene.  In  attempting  to  collect  a  suitable  ap- 
propriation of  ideas  for  the  general  reader,  both 
child  and  adult,  it  is  somewhat  difficult,  as  any- 
one with  similar  experience  knows,  to  write  for 
their  understanding  without  entangling  oneself  in 
the  meshes  of  at  least  some  technical  details,  and, 
as  in  the  case  of  oral  prophylaxis,  difficult  to  avoid 
disputed  ground,  especially  in  regard  to  thera- 
peutics. So  it  was  with  these  snares  in  mind  that 
I  have  tried  to  make  the  scientific  matter  as  simple 
as  possible  and  the  practical  advice  as  nearly  cor- 
rect as  the  majority  of  the  authoritative  opinions 
of  the  dental  profession  would  warrant,  it  having 
been  my  idea  to  leave  untouched  any  point  of 
unsettled  value,  especially  in  regard  to  the  late 
theories  of  Pickerill  and  Gies  concerning  the  use 
of  organic  acids  rather  than  alkaline  fluids.  I 
have  written  in  a  positive  manner  upon  the  op- 
portunity for  general   disease   resulting  from   a 


vi  PREFACE 

primary  dental  source  of  infection,  which  fact  is 
now  generally  conceded  by  both  the  dental  and 
medical  profession.  Above  all  I  have  tried  to 
impress  upon  the  reader  the  constant  necessity  of 
professional  co-operation. 

In  the  preparation  of  the  manuscript  I  have 
had  occasion,  of  course,  to  refer  to  other  books 
and  to  numerous  writers  on  the  subject  in  various 
journals,  to  all  of  whom  I  acknowledge  my  in- 
debtedness, and  during  the  course  of  which  work 
I  was  assisted  by  my  wife.  The  photographs  I 
have  duly  accredited  and  the  drawings  have  been 
purposely  made  as  simple  as  possible  by  myself. 

If  the  resume  following  of  oral  hygiene  is  as 
useful  as  the  cause  for  which  it  was  written  is 
good,  I  am  sure  this  little  volume  will  find  no 
few  friends. 

Joseph  H.  Kauffmann. 

601  West  177th  Street, 
New  York  City. 


CONTENTS 

CHAPTER  I. 

ALLY  InTERESTE 

AND  Teeth 1 


PAGE 

Why  We  Are  Especially  Interested  in  the  Mouth 


CHAPTER  n. 

The  Relationship  of  the  Oral  Cavity  to  the  Rest 

OF  the  Body 5 

CHAPTER  HI. 

The  Structure  and  Functions  of  the  Mouth  and 

Teeth 12 

CHAPTER  IV. 

Results  of  Neglecting  the   Cleanliness  of  the 

Oral  Cavity 28 

CHAPTER  V. 
Measures  of- Oral  Hygiene 44 

CHAPTER  VI. 
Beneficial  Results  of  Oral  Hygiene      ...     64 

INDEX (i7 


CARE  OF  THE  MOUTH  AND 
TEETH 

CHAPTER  I 

WHY  WE  ARE  ESPECIALLY  INTERESTED  IN  THE 
MOUTH  AND  TEETH 

The  chief  purpose  of  this  book  is  to  tell  in 
a  simple  manner  how  and  why  we  should  faith- 
fully preserve  the  healthful  condition  of  the 
mouth  and  teeth  and  so  help  to  perfect  ourselves 
physically,  mentally  and  morally. 

We  will  do  this  by  explaining  as  the  names 
of  the  chapters  indicate: 

First:  Why  we  are  especially  interested  in  the 
mouth  and  teeth. 

Second:  The  relationship  of  the  oral  cavity 
to  the  rest  of  the  body. 

Third:  The  structure  and  functions  of  the 
mouth  and  teeth  in  particular. 

Fourth:  Results  of  neglecting  the  cleanliness 
of  the  oral  cavity. 

Fifth:  Measures  of  oral  hygiene  or  how  to 
keep  healthy  the  mouth  and  teeth. 


2  CARE  OF  THE  MOUTH  AND  TEETH 

Sixth:  Beneficial  results  of  oral  hygiene. 

During  the  course  of  these  chapters  we  shall 
discuss  many  points  of  interest  which  will  serve 
as  stepping-stones  in  impressing  upon  our  minds 
the  chief  purpose,  as  first  stated,  of  this  book. 

The  proper  and  scientific  name  for  the  mouth 
is  the  oral  cavity,  which  brings  us  to  the  subject 
of  our  book,  or  oral  hygiene. 

Oral  hygiene  is  that  study  which  enables  us 
to  learn  how  to  better  preserve  our  health  and 
guard  against  disease  by  faithfully  using  all  the 
ways  and  means  at  our  command  which  will  keep 
the  mouth  and  teeth  in  healthful  condition. 

It  is  always  our  earnest  desire  to  be  healthy, 
both  for  our  own  sakes  and  for  the  good  of  those 
about  us.  In  the  past  it  has  been  the  fashion  to 
speak  chiefly  about  curing  disease,  but  now  we 
speak  a  good  deal  more  about  preventing  disease, 
and  it  is  being  proved  more  and  more  that  "an 
ounce  of  prevention  is  worth  a  pound  of  cure." 
We  first  learn  to  take  bodily  care  of  ourselves 
•by  instinct  or  natural  intuition  when  we  are  mere 
infants.  When  a  baby  first  learns  to  walk  he 
takes  hold  of  the  corner  of  a  chair  so  as  to  sup- 
port himself,  knowing  that  to  fall  would  hurt  him. 
And  so  this  instinct  develops  gradually  in  such 


.  CARE  OF  THE  MOUTH  AND  TEETH  3 

a  way  that  besides  natural  inclinations  we  observe 
all  the  safeguards  to  health  which  we  are  taught; 
for  instance,  in  trying  to  obtain  proper  and  suffi- 
cient food,  In  proper  clothing,  in  obtaining  suffi- 
cient exercise  and  rest,  in  bodily  cleanliness,  in 
avoiding  dangerous  occupations  or  unsafe  sur- 
roundings, in  having  ourselves  vaccinated  so  as 
to  prevent  disease  such  as  smallpox  and  in  numer- 
ous other  ways  of  which  these  serve  as  examples. 
But  to-day  we  have  advanced  still  further  in  that 
we  not  alone  use  all  those  means  that  are  usually 
carried  out  of  preserving  our  bodies  in  general,  but 
we  also  take  a  particular  interest  in  another  im- 
portant factor  of  health,  namely,  the  cleanliness 
of  the  mouth  and  teeth  or  oral  hygiene.  This  is 
because  through  past  experience  we  realize  what 
important  functions  our  mouths  and  teeth  serve; 
we  realize  how  closely  related  they  are  to  the  wel- 
fare of  the  rest  of  the  body;  what  serious  conditions 
can  arise  from  their  neglect;  how  we  can  avoid 
these  conditions  by  observing  the  elementary  prin- 
ciples of  cleanliness  and  what  benefits  may  arise  in 
doing  so.  Throughout  the  world  this  spirit  of  oral 
hygiene  has  grasped  people  of  all  ages  and  races, 
although  up  to  this  time  we  have  gone  along  with- 
out paying  enough  attention  to  the  very  entrance, 


4  CARE  OF  THE  MOUTH  AND  TEETH 

as  it  were,  of  the  body.  Due  to  the  fact  that  our 
parents,  teachers,  and  medical  advisers  have  al- 
ways faithfully  endeavored  to  help  us  as  children 
become  healthy  and  useful  men  and  women,  we 
have  made  great  strides ;  but  how  much  more  good 
will  be  done  in  future  years  and  how  much  more 
war  will  be  waged  against  disease  by  the  practise 
of  oral  hygiene!  Like  all  other  campaigns  in  the 
cause  of  health  and  prevention  of  disease,  this  one 
of  oral  hygiene  will  bring  us  to  a  still  greater 
degree  of  physical  and  hence  mental  and  moral 
perfection,  because  the  healthier  our  bodies  the 
sounder  our  minds  and  the  finer  our  ideals!  And 
as  the  engineer,  chemist,  electrician,  educator, 
statesman,  physician,  and  scientist  of  every  turning 
each  has  his  opportunity  to  forward  civilization 
in  its  wonderful  march  toward  perfection,  so  to- 
day has  the  dentist,  upon  whom  the  perfection  of 
this  great  movement  rests,  the  opportunity  to  serve 
as  a  helpful  factor  in  the  benevolence  of  mankind 
and  the  improvement  of  the  human  race. 


CHAPTER  II 

THE  RELATIONSHIP  OF  THE  ORAL  CAVITY  TO  THE 
REST  OF  THE  BODY 

Let  us  consider  for  a  moment  the  body  as  a 
whole.  We  first  refer  to  its  general  construction, 
or  what  is  termed  anatomy.  We  next  speak  of 
the  functions  of  the  various  parts  constituting  the 
body,  or  our  physiology.  And  if  we  were  further 
interested,  as  some  of  us  will  perhaps  be,  we  might 
examine  the  finer  tissues  of  the  body  very  minutely 
under  the  microscope,  this  study  being  called  his- 
tology. In  doing  so  we  would  discover  little  cells 
making  up  our  various  tissues,  which  forming  the 
basis  of  our  bodies  are  called  elementary  units  of 
living  matter,  and  when  many  cells  of  one  kind 
are  grouped  together  the  result  is  a  tissue.  But 
for  our  present  purpose  we  need  only  gather  a  few 
simple  facts  concerning  our  anatomy  and  leave 
further  study  of  these  structures  for  another  time 
and  place. 

We  all  know  the  body  is  built  upon  a  bony 
framework,  over  which  are  laid  various  tissues 
and  organs  that  serve  us  in  so  many  useful  ways. 
These  structures  are  closely  related  to  each  other 


6  CARE  OF  THE  MOUTH  AND  TEETH 

and  for  purposes  of  study  are  divided  into  groups, 
and  the  first  of  these  groups  to  interest  us  is  the 
digestive  apparatus,  or  organs  of  digestion. 

The  alimentary  or  digestive  canal  is  a  long  tube 
about  thirty  feet  in  length,  lined  by  a  soft  tissue 
called  mucous  membrane,  which  is  similar  in  pur- 
pose to  the  skin  that  covers  the  body  without.  The 
principal  organs  of  this  apparatus  are  the  mouth, 
pharynx,  oesophagus,  stomach,  small  and  large  in- 
testines, and  these  are  assisted  in  their  work  by 
the  teeth,  salivary  glands,  liver,  pancreas  and 
spleen,  which  are  called  accessory  organs  of  di- 
gestion. 

Let  us  see  the  path  the  food  takes  in  its  passage 
through  the  digestive  canal.  The  lips,  two  in 
number,  serve  as  the  entrance  to  the  mouth  and 
lead  into  the  interior  of  the  oral  cavity,  which  we 
will  describe  in  detail  later.  We  next  pass  into 
the  upper  part  of  the  throat  or  pharynx  and  de- 
scend into  a  long  tube  called  the  oesophagus, 
which  leads  into  the  largest  organ  of  digestion, 
the  stomach.  From  the  stomach  we  pass  into  the 
small  intestines,  with  which  the  liver,  spleen  and 
pancreas  communicate  to  assist  in  the  preparation 
of  the  food  for  its  use  by  the  body  tissues.  Here 
most  of  the  food  after  being  prepared  is  taken  up 


CARE  OF  THE  MOUTH  AND  TEETH  7 

for  use  by  the  tissues  of  the  body  and  a  smaller 
amount  passes  into  the  large  intestines,  where  a 
little  more  is  taken  up  and  the  remainder,  or  waste, 
chiefly  solid  matter,  is  thrown  off.  Although  we 
will  not  go  into  details  covering  the  functions  of 
these  parts,  it  is  best  that  we  have  glanced  over  all 
of  those  organs  having  something  to  do  in  the 
task  of  digestion. 

Besides  a  brief  knowledge  of  these  organs,  it 
is  important  to  know  how  they  communicate  with 
each  other  and  indirectly  with  all  the  other  cells 
of  the  body. 

Nutrition,  or  the  feeding  of  the  body,  is  car- 
ried on  by  two  sets  of  organs,  called  the  blood 
vessels  and  lymphatics,  which  contain  two  fluids 
essential  to  life,  called  blood  and  lymph. 

The  blood  vessel  system  originates  in  the  heart, 
which  is  the  pumping  station  for  the  supply  of 
blood  to  all  the  tissues  of  the  body,  no  matter  how 
small  they  may  be.  This  it  does  by  means  of  tube- 
like structures  called  arteries,  capillaries  and  veins. 
The  arteries  and  capillaries  carry  chiefly  nutri- 
tional substances,  while  the  veins  take  up  chiefly 
the  waste  matter  and  poisonous  gases  from  the 
tissue  cells.  But  the  blood  does  not  have  its  choice 
of  selecting  one  particular  place  in  which  to  store 


8  CARE  OF  THE  MOUTH  AND  TEETH 

Up  food,  but  passes  through  every  part  of  the  body 
after  it  leaves  the  heart,  and  before  it  returns,  thus 
making  what  is  termed  a  complete  circuit  of  the 
body  cells.  So  that  when  it  bathes  the  cells  of 
the  oral  cavity,  it  goes  back  to  the  heart,  thence 
to  the  lungs  to  be  refreshened  with  pure  oxygen  and 
give  off  Its  principal  waste  or  poisonous  gas  called 
carbon  dioxide,  after  which  it  returns  again  to 
the  heart,  is  sent  through  the  digestive  organs  for 
food  material,  and  finally  returns  in  a  freshened 
state  to  supply  the  oral  cavity  from  whence  we 
started.  We  thus  see  that  our  mouths  have  rela- 
tionship with  many  other  parts  of  the  body,  be- 
cause of  the  connecting  agent  or  blood. 

We  mentioned  before  the  lympH  system.  This 
resembles  the  blood  vessel  system  in  that  it  follows 
the  blood  vessels  all  over  the  body  and  assists  them 
by  carrying  through  little  tubes,  called  lymphatics, 
food  from  the  small  blood  vessels  to  the  cells  and 
waste  from  the  cells  into  the  small  veins,  besides 
which,  by  means  of  vessels  in  the  digestive  tract, 
called  lacteals,  it  distributes  fatty  substances  col- 
lected from  the  intestines  to  the  blood  for  use  by 
the  tissue  cells.  As  it  helps  to  bring  blood  and 
tissue  cells  into  communication,  it  is  called  the 
"middleman"  of  the  body. 


CARE  OF  THE  MOUTH  AND  TEETH  9 

We  should  also  consider  an  important  set  of 
structures  called  nerves.  The  nervous  system 
comprises  the  brain,  spinal  cord,  and  their  mes- 
sengers called  nerves,  w^hich  latter,  when  large, 
are  like  threads  and  when  small  like  very  fine 
fibres.  These  when  acting  with  one  another  serve 
several  purposes. 

Firstly — To  warn  us  of  danger  by  causing  the 
sensation  of  pain;  for  instance,  in  toothache. 

Secondly — To  help  move  our  bodies  and  se- 
cure all  voluntary  movements,  as,  for  instance, 
chewing  food,  by  means  of  messages  sent  from  the 
brain  along  the  nerves  connected  with  the  mus- 
cles, by  whose  contraction  the  desired  movements 
of  the  jaw  take  place. 

Thirdly — By  conducting  messages  from  one 
part  of  the  body  to  another,  thus  keeping  our  or- 
gans in  sympathy  with  one  another  for  their  mu- 
tual benefit;  for  instance,  in  eating  dry  food  we 
immediately  notice  our  mouths  fill  with  saliva  of 
a  watery  quality,  thus  making  it  easier  for  the 
food  to  be  masticated  so  as  to  be  better  digested. 
Thus  the  salivary  glands  assist  the  digestive  organs 
in  their  work,  although  the  action  is  undesired  in 
our  minds  or  involuntary. 

We  have  also  to  consider  our  respiratory  appa- 


lO  CARE  OF  THE  MOUTH  AND  TEETH 

ratus,  whose  parts  assist  in  the  interchange  of  gases 
between  the  body  and  the  atmosphere  in  which 
we  breathe  and  which  communicates  with  the  oral 
cavity.  Air  is  first  breathed  in  through  the  nose, 
whence  it  finds  its  way  by  means  of  passages 
through  the  nose  into  the  pharynx,  which  is  con- 
tinuous with  the  larynx  or  vocal  organ.  It  then 
continues  into  the  trachea,  hence  to  spreading  tube- 
like structures  called  bronchioles,  after  which  it 
enters  the  lungs  or  chief  organs  of  respiration. 
Here  the  blood  gives  up  its  carbon  dioxide  to, 
and  takes  up  fresh  oxygen  from,  the  air  we 
breathe. 

Finally,  we  might  mention  the  kidneys,  where 
the  blood  is  drained  of  its  liquid  waste,  which  is 
later  thrown  off  in  order  to  relieve  the  tissues  of 
undesired  matter.  We  now  understand  that  the 
kidneys,  lungs,  and  the  intestines,  in  purifying  the 
blood,  have  indirectly  received  the  waste  of  the 
oral  cavity. 

We  have  thus  briefly  reviewed  for  one  impor- 
tant reason  many  factors  of  health,  all  of  which 
are  related  to  the  oral  cavity,  and  hence  with  our 
teeth.  Not  because  we  are  studying  these  organs 
by  themselves,  but  for  the  very  fact  that  we  wish 
to  show  their  relationship  to  the  mouth  and  teeth. 


CARE  OF  THE  MOUTH  AND  TEETH  II 

And  as  the  oral  cavity  is  constantly  in  communi- 
cation by  means  of  lymph  and  blood  with  every 
other  part  of  the  body,  it  is  important  that  its  con- 
tents, particularly  the  teeth,  be  in  as  healthful  a 
state  as  possible  so  as  to  uphold  the  health  of  the 
rest  of  the  body;  for  If  not  so,  the  blood,  w^hich 
passes  through  its  tissues,  communicating  with  the 
teeth,  will  serve  as  a  source  of  danger  to  all  the 
other  parts  with  which,  as  we  have  seen,  it  must 
necessarily  come  in  contact.  Not  only  this,  but 
when  we  realize  that  all  the  food  we  partake 
of  goes  firstly  through  the  oral  cavity,  when  we 
realize  the  relationship  of  the  mouth  with  the  air 
we  breathe,  we  can  see  that  it  is  indeed  a  most 
important  protector  of  our  internal  welfare;  and 
when  we  study  its  important  functions,  especially 
those  of  the  teeth,  we  can  appreciate  the  vital 
importance  of  oral  hygiene,  which  not  alone  con- 
serves the  health  of  the  mouth  and  teeth,  but  pre- 
vents many  undesired  conditions  amongst  which 
number  numerous  diseases ;  all  of  which  we  shall 
presently  speak  of,  after  becoming  more  intimate 
with  the  immediate  subject  of  our  book,  the  struc- 
ture and  functions  of  the  mouth  and  teeth  them- 
selves. 


CHAPTER  III 

THE  STRUCTURE  AND  FUNCTIONS  OF  THE  MOUTH 
AND  TEETH 

The  chief  points  of  interest  in  this  book  lie 
in  the  oral  cavity,  and  those  members  of  the  oral 
cavity  which  deserve  our  most  constant  attention 
are  the  teeth. 

The  oral  cavity  has  the  form  of  a  hollow  oval- 
shaped  space,  bounded  in  front  by  the  lips,  on  the 
sides  by  the  cheeks,  below  by  the  floor  of  the  mouth 
or  muscular  tissue  and  under  surface  of  the  tongue, 
above  by  the  hard  and  soft  palate,  and  behind  by 
the  entrance  to  the  throat  or  the  fauces. 

Within  the  cavity  of  the  mouth  we  find  the 
tongue,  which  aids  us  in  mastication,  deglutition 
or  swallowing,  speech  and  taste. 

Situated  within  the  mucous  membrane,  or  pro- 
tective lining  of  the  cheeks  and  floor  of  the  mouth, 
are  the  salivary  glands,  which  number  three  on 
each  side,  and  which  secrete  a  watery  fluid  called 
saliva,  that  is  always  present  bathing  the  tissues. 
These  are  assisted  bv  smaller  glands,  which  are 

12 


CARE  OF  THE  MOUTH  AND  TEETH  1 3 

situated  at  various  places  in  the  mucous  membrane 
throughout  the  mouth.  The  functions  of  the  saliva 
are  manifold. 

Firstly — It  assists  digestion  by  means  of  a  fer- 
ment which  it  contains,  called  ptyalin.  This  con- 
verts starchy  and  complex  sugary  foods  into  a 
simple  sugar  called  glucose. 

Secondly — It  moistens  the  food  and  thus  makes 
it  easier  to  chew. 

Thirdly — It  moistens  the  oral  cavity,  making 
it  easier  for  the  food  to  be  passed  about  from  one 
part  to  another  during  mastication,  and  at  the 
same  time  helps  the  free  movement  of  the  tongue. 

Fourthly — It  removes  the  food  from  the  folds 
of  the  cheeks  and  lips,  thus  preventing  its  collec- 
tion and  decomposition. 

Fifthly — It  acts  as  a  guide  in  digestion  by  flow- 
ing readily  when  we  are  hungry,  see  or  smell  some- 
thing that  we  desire  to  eat. 

Sixthly — It  helps  us  to  secure  enough  fluid  food 
by  indicating  through  its  decrease  in  secretion  the 
sensation  of  thirst. 

Seventhly — It  is  a  cleansing  agent  for  all  the 
tissues  and  the  teeth,  which  makes  it  very  valuable 
as  a  safeguard  to  health. 

Although  the  saliva  is  ninety-nine  and  one-half 


14  CARE  OF  THE  MOUTH  AND  TEETH 

per  cent,  water,  by  means  of  the  salts  and  ferment 
it  contains,  its  action  is  a  most  important  one, 
making  it  altogether  a  wonderful  fluid. 

The  next  members  of  the  oral  cavity,  last  but 
not  least,  are  the  teeth.  The  teeth  are  specialized 
hardened  organs,  situated  in  the  softened  portion, 
or  alveolar  process,  of  the  jawbones,  whose  chief 
function  is  to  aid  in  mastication  of  food.  Of  jaw- 
bones in  which  the  teeth  are  lodged  we  have  three, 
two  above  which  are  immovable,  and  one  below 
which  is  movable. 

Most  animals  possess  teeth  varying  in  form, 
function  and  number,  according  to  the  peculiar 
needs  of  the  individual  animal.  Some  animals 
possess  teeth  for  the  purpose  of  preying  upon 
other  animals;  some  for  purposes  of  seizing  vege- 
table material  for  food.  The  former  of  these  are 
called  carnivora,  or  flesh-eating  animals,  and  the 
latter  are  called  herbivora,  or  vegetable-eating 
animals.  We  ourselves,  who  belong  to  the  type  of 
animal  whose  scientific  classification  is  in  the  Latin 
language  genus  homo,  or  man,  are  a  combination 
of  these  two  types.  That  is,  we  eat  both  animal 
and  vegetable  food,  and  are  therefore  called  om- 
nivorous, which  is  derived  from  the  Latin  omnis, 
all,  and  voro,  I  eat.     Some  of  our  teeth  are  for 


CARE  OF  THE  MOUTH  AND  TEETH  1 5 

crushing,  cutting  and  grinding  vegetable  food, 
while  others  are  for  seizing,  tearing,  cutting, 
grinding  and  crushing  animal  food. 

Man,  like  many  other  animals,  possesses  dur- 
ing a  lifetime  two  sets  of  teeth;  one  for  early 
infancy  and  childhood,  which  are  called  tempo- 
rary or  deciduous  teeth,  and  another  set  replacing 


A        B        C  D  E 

Fig.  1.— Temporary  Teeth,  Left  Side.     (Burchard) 

A.    Central  Incisor  B.    Lateral  Incisor  C.    Cuspid 

D.    First  Molar  E.    Second  Molar 

these  and  serving  until  old  age,  named  perma- 
nent or  secondary  teeth.  In  the  temporary  set  we 
have  twenty  teeth,  in  the  permanent  set  thirty-two, 
making  fifty-two  in  all. 

For  purposes  of  scientific  classification  each  set 
is  given  a  dental  formula,  that  is,  an  equation  rep- 
resenting the  kind,  number  and  relative  position 
of  the  teeth  in  each  set. 


1 6  CARE  OF  THE  MOUTH  AND  TEETH 

The  dental  formula  for  the  temporary  set  is 
as  follows: 

Iff    Cll    M||  =  20 

The  meaning  of  this  equation  is  as  follows: 
I,  or  incisors,  two  above  and  two  below  on  each 
side  of  the  median  line  or  middle  of  the  face, 


Fig.  2.— Permanent  Teeth,  Right  Side.     (Burchard) 

A.    Central  Incisor  B.    Lateral  Incisor  C.    Cuspid 

D.    First  Bicuspid  E.    Second  Bicuspid  F.    First  Molar 

G.    Second  Molar  H.    Third  Molar 


called  central  and  lateral  incisors.  C,  or  cuspids, 
one  above  and  one  below  on  each  side  of  the  me- 
dian line.  M,  or  molars,  two  above  and  two  below 
on  each  side  of  the  median  line.    Making  twenty 


CARE  OF  THE  MOUTH  AND  TEETH  1 7 

in  all,  or,  in  other  words,  on  each  side,  both  right 
and  left  of  the  upper  jaw,  are  five  teeth,  making 
ten  above;  on  each  side  of  the  lower  jaw  are  five 
teeth,  making  ten  below,  and  both  jaws  together 
hold,  therefore,  twenty  teeth. 

The  dental  formula  for  the  permanent  teeth  is 
as  follows: 

122        ril        R2.2.       M    ^    ^   —    '\? 
BL  RL  BL  RL 

In  this  formula  we  note  the  letter  B,  which 
stands  for  bicuspids,  adding  two  more  teeth  on 


Fig.  3.— External  Appearance  of  Lower  Molar 
A.    Crown  of  Lower  Molar       B.    Neck       C.    Root       D.    Apex  of  Root 

each  side  of  the  median  line  both  above  and  below; 
and  we  also  note  three  molars  on  each  side,  above 
and  below,  instead  of  two  as  in  the  temporary  set. 
In  the  second  set  the  incisors  and  cuspids  take 
approximately  the  same  place  as  the  correspond- 
ing teeth  in  the  temporary  set,  and  the  bicuspids 
or  premolars  occupy  the  place  formerly  held  by 


1 8  CARE  OF  THE   MOUTH  AXD  TEETH 

the  temporar}^  molars,  there  being  no  temporary 
bicuspids.  The  permanent  molars  gradually  ap- 
pear behind  the  position  held  by  the  second  tem- 
porary molars. 

Each  tooth  has  certain  characteristics  common 
to  all  of  the  teeth;  that  is,  each  tooth  has  a  crown, 
a  root  or  more  than  one,  neck  and  pulp  cavity. 

The  crown  is  that  portion  of  the  tooth  covered 
with  enamel,  and  able  to  be  seen  projecting  beyond 
the  gum. 


Fig.  4. — Internal  Appearance  of  Lower  Molar 
A.    Enamel  of  Tooth       B.    Dentine       C.    Pulp        D.    Cementum 

The  root  is  that  portion  of  the  tooth  covered 
with  cementum  and  placed  in  the  jaw-bone,  being 
hidden  by  the  gum  or  that  portion  of  the  mucous 
membrane  surrounding  it. 

The  neck  is  that  portion  of  the  tooth  which 
is  constricted  at  the  junction  of  cementum  and 
enamel,  joining  the  crown  and  the  root. 


CARE  OF  THE  MOUTH  AND  TEETH  19 

The  pulp  cavity  is  a  hollowed  cavity  within 
the  crown  and  the  root  containing  the  pulp.  It 
may  be  subdivided  into  pulp  chamber,  or  that  part 
of  the  cavity  within  the  crown,  and  the  pulp  or 
root  canal,  or  that  part  within  the  root,  one  being 
continuous  with  the  other. 

These  are  termed  the  anatomical  divisions  of 
the  tooth.  Again,  we  find  that  these  anatomical 
parts  are  themselves  made  up  of  particular  kinds 
of  cells  and  tissues,  five  in  number. 

The  crown  of  the  tooth  Is  covered  by  a  tissue 
called  enamel,  which  is  the  hardest  substance  in 
the  body.  The  enamel  is  composed  of  two  kinds 
of  material,  one  of  which  is  Inorganic,  the  latter 
not  possessing  the  structure  of  living  tissue  cells, 
but  composed  of  various  salts  comprising  minute 
tubes  called  enamel  rods,  which  are  held  together 
by  other  softer,  cellular,  vital  or  organic  substance 
almost  negligible  in  quantity.  Besides,  water  Is 
present,  like  In  all  tissues.  The  enamel  of  adults 
is  denser  than  that  of  children. 

The  root  of  the  tooth  is  covered  by  a  bony  sub- 
stance called  cementum,  which  in  many  ways  re- 
sembles bone.  It  Is  about  two-thirds  Inorganic  and 
one-third  organic,  and,  like  enamel.  Is  thickest  in 
adult  life.     It  Is  closely  connected  with  the  den- 


20  CARE  OF  THE  MOUTH  AND  TEETH 

tine  within  the  root,  and  meets  the  enamel  at  the 
neck  of  the  tooth. 

Externally  to  it  is  the  pericementum,  which  is 
a  fibrous  tissue  that  connects  it  with  the  jaw-bone 
or  alveolar  process,  in  which  the  root  is  placed. 
It  is  this  tissue  that  supplies  the  tooth  with  the 
sense  of  touch. 

The  dentine  comprises  the  bulk  or  body  of  the 
tooth,  that  is,  all  of  the  solid  portion  of  the  tooth 
beneath  enamel  and  cementum.  While  not  as  hard 
as  enamel  or  cementum,  it  is  harder  than  bone. 
It  is  about  two-thirds  inorganic  and  one-third  or- 
ganic in  structure,  and  contains  very  fine  little 
tubes,  called  dentinal  tubules  which  run  from  be- 
neath the  enamel  and  cementum  into  the  pulp. 
It  Is  yellowish-white  in  color,  and  upon  its  color 
and  the  translucency  of  the  enamel  is  the  general 
shade  of  the  tooth  dependent  when  in  a  healthful 
condition;  as  a  rule,  the  darker  the  dentine  the 
darker  the  tooth. 

Within  the  pulp  cavity  we  find  a  small  amount 
of  organic  tissues  consisting  of  minute  blood  ves- 
sels, cells  and  nerves,  but  which  is  erroneously 
spoken  of  as  the  "nerve,"  because  of  the  idea  that 
a  dreadful  pain  will  result  when  the  pulp  is 
touched  or  irritated,  consequently  the  result  of  the 


CARE  OF  THE  MOUTH  AND  TEETH  21 

misbehavior  of  the  "live  nerve."  The  pulp, 
through  its  blood  vessels,  gives  nutrition  to  the 
tooth,  and  by  means  of  its  nerves  supplies  the  tooth 
with  a  messenger  of  warning  in  case  of  danger. 
However,  if  we  were  to  touch  a  healthy  pulp  in 
perfect  condition  and  not  irritated  by  any  external 
means,  no  pain  would  result  whatsoever. 

The  temporary  teeth  in  many  ways  resemble 
permanent  teeth.  There  are,  however,  some  dif- 
ferences. Firstly,  and  most  marked  of  all,  they 
are  much  whiter;  secondly,  their  enamel  is 
coarser;  thirdly,  the  constriction  of  the  neck  is 
more  marked;  fourthly,  they  are  smaller  than  the 
corresponding  permanent  teeth;  and  lastly,  their 
roots  spread  farther  apart  to  allow  for  the  crowns 
of  the  incoming  permanent  teeth. 

The  reason  we  have  fewer  temporary  than  per- 
manent teeth  is  that  our  jaw-bones  are  not  fully 
developed  enough  to  hold  any  more,  because  na- 
ture molds  the  structures  of  the  body  in  accord- 
ance with  our  needs,  and  as  the  temporary  teeth 
are  only  in  our  mouths  during  the  first  twelve 
years  of  life,  approximately  speaking,  they  are 
sufficient  to  meet  our  needs  for  those  early  years. 

When  infants  get  their  first  little  teeth  we 
speak  of  this  usually  as  "teething,"  although  the 


22  CARE  OF  THE  MOUTH  AND  TEETH 

proper  term  would  be  eruption  of  the  teeth.  By 
that  we  mean  the  process  in  which  the  teeth,  with 
their  crowns  fully  formed  and  their  roots  partly 
formed,  come  through  the  gums. 

Temporary  or  primary  dentition  occurs  be- 
tween the  ages  of  five  to  thirty -two  months,  the 
lower  teeth  usually  preceding  the  upper  teeth  in 
the  following  manner: 

Central  incisors   5  to     8  months 

Lateral  incisors 7  to  10  months 

First  molars   12  to  16  months 

Cuspids   14  to  20  months 

Second  molars 20  to  32  months 

Of  course  these  ages  may  vary  in  different  in- 
dividuals. 

As  nature  does  not  desire  our  temporary  teeth 
to  remain  very  many  years,  she  starts  to  build  our 
second  teeth  while  the  first  ones  are  yet  in  place, 
and  when  we  are  old  enough  to  have  our  second 
teeth  she  paves  the  way  for  them  by  gradually 
shortening  their  roots,  by  what  is  termed  the  pro- 
cess of  resorption,  in  which  they  gradually  dis- 
appear. This  is  why,  when  we  are  about  to  get 
our  second  teeth,  our  first  ones  become  loosened 
through  the  lack  of  support.     On  the  other  hand 


CARE  OF  THE   MOUTH   AND  TEETH  23 

should  they  have  been  so  badly  decayed  as  to  have 
been  "dead"  teeth  or  teeth  with  a  dead  pulp,  root 
resorption  does  not  occur.  As  we  gradually  lose 
all  our  first  teeth  our  jaw-bones  are  developing 
in  width,  depth,  and  length,  so  as  to  be  able  to 
accommodate  the  wider,  longer,  larger  and  more 
numerous  permanent  teeth,  at  the  same  time  grow- 
ing in  harmony  with  the  other  structures  of  our 
body. 

Although  our  teeth  are  erupted  at  the  ages 
previously  given  they  are  not  yet  complete,  but 
keep  on  forming  from  neck  downwards  until  the 
entire  root,  to  the  end  or  apex,  is  built  up,  the 
latter  part  being  the  last  to  be  finished.  About 
a  year  after  the  complete  formation  of  the  tem- 
porary teeth  the  process  of  resorption  begins  and, 
as  explained,  the  first  teeth  are  lost  to  give  place 
to  the  succeeding  permanent  teeth.  First  the  cen- 
tral incisors,  then  the  lateral  incisors,  next  the  first 
molars,  then  the  second  molars  and,  lastly,  the 
cuspids  are  lost,  each  one  being  immediately  suc- 
ceeded by  a  permanent  tooth. 

Secondary  dentition  starts  at  about  the  sixth 
year  with  the  appearance  of  the  first  permanent 
or  six  year  molars  which  arise  directly  behind  the 
temporary  second  molar.     An  approximate  table 


24  CARE  OF  THE  MOUTH  AND  TEETH 

for   the   eruption   of   the   permanent  teeth   is  as 
follows : 

First  molars 5  to  7  years 

Central  incisors 6  to  8  years 

Lateral  incisors 7  to  9  years 

First  bicuspids 8  to  10  years 

Second  bicuspids 9  to  11  years 

Cuspids 10  to  12  years 

Second  molars 11  to  13  years 

Third  molars. 17  years  or  later 

The  third  molars  or  wisdom  teeth  are  fre- 
quently absent  or  may  be  held  back  in  the  jaw- 
bone through  lack  of  room  to  erupt  or  other  rea- 
sons not  necessary  to  be  discussed  here.  However, 
we  see  that  at  the  age  of  seventeen  not  alone  have 
we  lost  all  our  temporary  teeth,  but  we  may  have 
our  complete  set  of  permanent  teeth,  including  the 
third  molar. 

Let  us  now  consider  the  various  functions  of 
our  teeth.  Firstly  our  teeth,  because  of  their  vari- 
ous shapes  and  positions,  have  individual  work  to 
do  in  mastication. 

The  incisors  are  used  for  cutting  or  incising 
food;  that  is,  after  the  food  is  in  our  mouths  we 


CARE  OF  THE   MOUTH  AND  TEETH  25 

use  the  incisors  to  divide  it  into  smaller  portions. 
Each  incisor  has  one  root. 

The  cuspid  is  our  most  prehensile  tooth,  that 
is,  it  is  best  adapted  to  seizing  and  tearing  animal 
food,  resembling  the  teeth  always  present  in  flesh- 
eating  animals.  It  also  has  one  root,  which  is  the 
longest  and  strongest  of  any  in  the  mouth. 

The  bicuspids,  or  premolars  as  they  are  some- 
times called,  derive  their  name  from  the  fact  that 
they  have  two  cusps.  They  are  smaller  than  the 
temporary  molars  and  in  this  way  allow  for  the 
increased  space  needed  by  the  permanent  cuspids, 
which  are  larger  than  the  temporary  cuspids  and 
erupt  after  the  bicuspids  are  in  position.  Some 
bicuspids  have  two  and  some  one  root.  Their 
function  is  to  divide  the  food  into  small  pieces 
and  prepare  it  for  chewing  by  the  molars. 

The  molars  vary  more  than  any  of  the  other 
teeth  in  size,  form  and  function,  having  four  cusps 
or  more,  and  two  or  more  roots,  according  to  their 
situation ;  usually  two  when  in  the  lower  and  three 
or  more  when  in  the  upper  jaw.  These  cusps, 
by  catching  the  food  between  them  when  in  con- 
tact with  the  cusps  of  the  teeth  in  the  opposite 
jaw,  grind  and  crush  it,  as  a  final  step  in  its  mas- 
tication. 


26  CARE  OF  THE  MOUTH  AND  TEETH 

The  functions  of  the  temporary  teeth  resemble 
those  of  the  similar  teeth  in  the  permanent  set 
and  do  not  need  any  separate  explanation. 

Knowing  now  the  elementary  facts  of  the  teeth 
individually  we  should  glance  at  them  collectively. 
If  they  are  arranged  in  a  regular  manner,  that  is, 
speaking  of  the  permanent  set,  they  form  in  each 
jaw  a  rounded  curve  or  ellipse,  that  of  the  upper 
jaw  being  a  little  rounder  than  the  lower,  so  that 
the  upper  teeth  slightly  overlap  the  lower  teeth 
and  are  so  arranged  that  all  of  the  upper  or 
biting  surfaces  come  into  contact  with  those  of 
the  opposite  jaw,  thus  perfectly  allowing  for  the 
thorough  mastication  of  the  food  to  assist  in  diges- 
tion. Every  tooth  in  each  jaw  meets  two  teeth  in 
the  opposite  jaw,  with  the  exception  of  the  upper 
third  molars  and  lower  central  incisors.  This  is 
plainly  shown  in  the  illustration  (Fig.  5). 

Besides  the  function  of  the  teeth  in  mastica- 
tion they  serve  us  in  speech,  and  by  their  rela- 
tionship with  the  lips,  tongue,  cheek  and  palate 
make  possible  the  formation  of  various  sounds,  or 
vocalization. 

Knowing,  then,  these  elementary  facts  concern- 
ing the  healthy  oral  cavity,  we  will  look  at  it 
from    another    standpoint,  that  is,  we  will  next 


Fig.  5. 


CARE  OF  THE  MOUTH  AND  TEETH  27 

glance  over  some  results  of  its  unhealthful  con- 
dition and  by  observing  the  effects  of  neglecting 
the  mouth  and  teeth,  help  emphasize  upon  our 
minds  the  absolute  necessity  of  oral  hygiene. 


CHAPTER  IV 

RESULTS  OF   NEGLECTING  THE  CLEANLINESS  OF 
THE  ORAL  CAVITY 

We  often  hear  people  speak  of  decayed  teeth, 
but  hardly  ever  stop  to  think  of  their  evil  conse- 
quences. Let  us  see  what  happens  when  a  tooth 
becomes  decayed  and  how  it  is  brought  about. 

If  a  person  were  to  eat  a  meal  containing  some 
sugary  or  starchy  substance,  the  latter  would  be 
acted  upon  by  the  saliva,  which  would  convert  it 
into  glucose,  as  we  previously  remarked,  and  in 
all  probability  if  the  oral  cavity  were  not  thor- 
oughly cleansed  after  eating,  some  remnants  of 
this  glucose  would  remain  between  the  teeth  or 
be  held  by  means  of  a  gluey  substance  in  some  pit 
or  crevice  of  the  tooth.  Now  in  our  mouths  are 
always  present  hordes  of  microscopic  bodies  or 
germs,  amongst  which  are  a  kind  called  bacteria, 
whose  ability  to  flourish  and  grow  is  due  to  the 
presence  of  heat,  moisture  and  food  remnants, 
always  found  in  the  oral  cavity.  One  of  these 
bacteria,  called  the  bacillus  lactis,  or  lactic  acid 
forming  germ,  always  occurs  in  large  number,  so 

28 


CARE  OF  THE  MOUTH  AND  TEETH  29 

that  when  it  finds  the  glucose  to  feed  upon  it  causes 
a  fermentation,  or  chemical  change,  by  the  forma- 
tion of  two  parts  of  lactic  acid  from  one  part  of 
glucose.  Lactic  acid,  when  present,  is  the  active 
cause  of  tooth  decay,  and  it  first  acts  upon  the 
enamel,  seldom  attacking  the  root  of  the  tooth 
because  the  latter  is  guarded  by  the  gum  which 
surrounds  it.  When  the  lactic  acid,  after  being 
formed,  accumulates  upon  the  enamel,  it  eats  away 


Fig.  6. — Progress  of  Dental  Decay 

1.    Superficial  Stage  of  Decay  2.    Progressive  Stage  of  Decay 

3.   Deep-seated  Stage  of  Decay  4.    Complicated  Stage  of  Decay 


or  dissolves  the  salty  or  inorganic  material  of 
which  we  spoke  in  the  preceding  chapter.  How- 
ever, in  order  that  the  process  of  decay  may  con- 
tinue, another  kind  of  micro-organism  is  neces- 
sary to  destroy  the  organic  or  albuminous  part  of 
the  enamel.  This  is  done  by  what  are  called  sa- 
prophytic bacteria  or  germs  that  live  on  decom- 
posing organic  tissues.    Thus,  after  the  lactic  acid 


30  CARE  OF  THE  MOUTH  AND  TEETH 

Starts  the  destruction  of  the  enamel,  the  saprophytic 
germs  complete  it.  This  beginning  of  decay  in 
which  the  enamel  is  destroyed,  is  called  the  super- 
ficial stage  of  dental  caries,  which  latter  word 
means  decay. 

The  next  stage  of  decay  involves  the  dentine. 
The  process  of  decay  goes  on  in  the  same  manner, 
except  that  more  of  the  dentine  is  organic  than 
the  enamel,  and  therefore  the  saprophytic  germs 
play  a  more  important  part  than  in  superficial 
decay.  It  is  at  the  beginning  of  the  progressive 
stage  of  decay,  as  it  is  called,  that  we  have  most 
pain,  because  when  the  very  ends  of  the  dentinal 
fibres  (in  reality  fine  extensions  of  the  nerves  in 
the  pulp)  which  lie  beneath  the  enamel  are  irri- 
tated, they  respond  by  causing  intense  toothache, 
due  to  the  fact  that  the  extreme  end  of  a  nerve, 
or  its  extension,  in  this  case  the  dentinal  tubule, 
is  its  most  sensitive  portion.  However,  it  must 
be  remembered  that  the  dentine  does  not  contain 
any  real  nerves,  but  by  means  of  its  thread-like 
processes  acts  as  the  messenger  between  the  enamel 
and  the  pulp. 

Naturally  when  our  teeth  decay,  we  start  to 
have  pain,  and  are  thus  warned  to  have  the  teeth 
affected  properly  treated  by  our  dentist  in  order 


CARE  OF  THE  MOUTH  AND  TEETH  3 1 

to  avoid  further  decay:  and  of  this  necessary  pro- 
cedure we  shall  speak  later. 

The  decay  may  go  still  further  if  treatment 
is  neglected  so  as  to  almost  reach  the  pulp,  when, 
because  of  its  deeply  inward  penetration,  it  is 
spoken  of  as  deep-seated  or  third  stage  of  caries. 

If,  however,  the  disease  goes  on  unchecked, 
the  pulp  is  involved  and  we  then  find  the  decay 
has  reached  the  last  or  complicated  stage,  at  which 
time  we  usually  have  to  sit  up  and  take  notice. 
This  is  well  known  to  any  one  who  has  been  un- 
fortunate enough  to  have  had  an  aching  pulp  or 
"exposed  nerve." 

As  we  have  now  traced  the  process  of  decay  to 
the  pulp  which  leaves  a  destroyed  portion  of  tooth 
or  cavity  of  decay  behind  it,  let  us  next  see  what 
this  may  result  in. 

Let  us  suppose  that  the  second  temporary  molar 
of  a  child  four  years  of  age  becomes  decayed:  if 
this  tooth  is  then  neglected  the  decay  goes  still 
further,  which  means  that  sooner  or  later  the  little 
child  will  have  a  severe  toothache.  But  suppose, 
as  is  usually  the  case  when  neglected,  that  the 
toothache  is  so  bad  and  the  decay  so  far  advanced 
as  to  necessitate  the  loss  of  the  tooth.  The  pain  is 
relieved,  but  what  happens? 


32  CARE  OF  THE  MOUTH  AND  TEETH 

The  loss  of  the  temporary  molar  will  eventu- 
ally affect  the  permanent  teeth  in  this  manner. 
Under  ordinary  circumstances,  the  first  of  the 
second  set  of  teeth,  or  six  year  molar,  would  come 
through  the  gums  at  the  age  of  six  years  and  assume 
its  correct  position  immediately  behind  the  second 
temporary  molar.  But  as  there  is  now  an  un- 
filled space  created  by  the  loss  of  this  temporary 
tooth,  the  permanent  molar  having  no  resistance 
in  front  to  keep  it  in  its  proper  position,  soon  starts 
to  move  forward  into  that  space  created  by  the 
removal  of  the  temporary  molar,  which  latter 
tooth  should  have  remained  until  the  age  of  ten, 
when  the  second  bicuspid  would  replace  it.  This 
is  only  the  beginning  of  trouble,  for  when  the 
bicuspid  is  ready  to  take  its  correct  position,  the 
molar,  having  moved  forward,  crowds  it  out  of 
place.  And  again  at  the  age  of  twelve,  when  the 
second  permanent  molar  erupts,  it  does  not  keep 
its  proper  place,  but  moves  forward  into  the  space 
caused  by  the  tilting  of  the  first  molar,  thus  mak- 
ing a  continuous  chain  of  irregularities.  Still 
we  are  not  yet  finished,  for  in  the  meanwhile  the 
upper  permanent  second  bicuspid  and  molars  on 
the  same  side  have  erupted,  and,  as  previously  ex- 
plained, should  so  meet  or  occlude  with  their  lower 


CARE  OF  THE  MOUTH  AND  TEETH  33 

opponents  or  antagonizing  teeth  as  to  evenly  meet 
their  upper  surfaces.  However,  as  the  lower  teeth 
have  become  irregularly  placed,  this  valuable 
function  is  lost  and  the  power  of  mastication  by 
all  the  teeth  in  the  irregular  region  is  almost  en- 
tirely destroyed,  because  the  cusps  and  biting  edges 
of  the  opposing  teeth  are  thrown  out  of  their  cor- 
rect relative  position. 

Thus  we  see  the  result  of  neglect  of  a  tem- 
porary tooth  upon  the  permanent  set.     Not  alone 
is  mastication  interfered  with,  but,  consequently, 
digestion,   because   if   our   food   Is   not  properly 
chewed,  a  greater  task  is  thrown  upon  the  rest  of 
the    digestive    organs,    principally    the    stomach, 
which  may  be  injured  by  having  to  do  the  work 
of  mastication  or  division  of  the  food  which  nature 
never  intended  and  which  should  have  been  done 
by  the  teeth.    Furthermore,  from  the  age  of  four, 
at  which  the  temporary  molar  was  extracted,  to 
the  age  of  ten,  when  the  bicuspid  taking  its  place 
arrives,  the  child  is  missing  one  tooth  to  aid  in 
mastication  and  speech,  which  early  adds  to  the 
harm   done   by  the   irregularities   succeeding   its 
removal. 

In  order  to  emphasize  the  sad  results  of  neglect 
of  the  temporary  teeth,  let  us  observe  some  other 


34  CARE  OF  THE  MOUTH  AND  TEETH 

occurrences,  following  the  loss  of  the  temporary 
molar  which  we  have  taken  for  an  example. 

When  the  permanent  teeth  become  irregu- 
larly placed  or  crooked,  as  we  traced  their  move- 
ments before,  they  cause  a  loss  of  the  correct  ap- 
pearance of  the  lips,  cheek  and  face  as  a  whole 
by  interfering  in  their  actions  and  proper  out- 
line. 

And  again  if  the  permanent  molars  are  not  cor- 
rectly placed  in  the  jaw-bones,  but  move  forward, 
the  bone  behind  them  receives  no  stimulus  or  im- 
pulse to  develop  properly,  and  so  does  not  grow 
in  harmony  or  proper  relationship  with  the  other 
structures  about  the  mouth  and  face. 

Having  used  the  first  permanent  molar  as  ex- 
ample, we  should  more  fully  consider  its  impor- 
tance. The  six-year  molar,  as  it  is  ordinarily 
called  because  of  the  age  at  which  it  usually 
erupts,  is  perhaps  the  most  neglected  and  diseased 
tooth  of  the  permanent  set.  The  chief  reason  why 
this  tooth  is  most  neglected  is  that  in  coming  into 
the  mouth  it  erupts  behind  the  last  temporary 
tooth  and  consequently  because  of  its  posterior 
position  no  importance  is  placed  upon  it,  the  idea 
being  that  it  is  only  a  temporary  tooth  and  will 
soon  be  lost.     So  it  is  neglected  and  is  often  so 


CARE  OF  THE  MOUTH  AND  TEETH  35 

diseased,    even    before    its    roots    are    completely 
formed,  that  its  removal  is  a  matter  of  compulsion. 
Why  is  the  six-year  molar  important?    Because 
it  is  the  keystone  to  the  second  set  of  teeth.    Al- 
lowing that  all  of  the  temporary  teeth  are  present, 
the  first  molar  which  always  erupts  in  its  correct 
position  will  serve  as  a  guide  to  the  proper  ar- 
rangement of  all  the  succeeding  permanent  teeth 
in  front  of  it  and  behind  it.     This  is  because,  be- 
ing the  largest  and  strongest    of    the    permanent 
teeth,  it  controls  the  proper  position  needed  for 
the  permanent  teeth  by  preserving  the  necessary 
amount  of  space  to  be  occupied  by  those  members 
in  front  of  it;  and,   as  we  remarked  before,  it 
stimulates  the  growth  of  the  jaw-bone  behind  it, 
to  allow  for  the  last  molars :  besides,  by  the  length 
of  the  first  molars  when  in  contact,  the  distance  be- 
tween the  upper  and  lower  jaws  is  determined. 

But  if  this  valuable  guide  is  so  badly  diseased 
that  it  must  be  lost,  there  then  arises  a  series  of 
disturbances  which  end  up  in  distorted,  ill-looking, 
improperly  arranged  mouths  and  teeth,  all  of 
which  are  reasons  for  their  stricter  preservation; 
while  due  to  the  irregularities  thus  caused  may  be 
a  more  serious  condition  in  which  the  teeth  be- 
come so  misplaced,  crooked  or  malposed,  that  the 


36  CARE  OF  THE  MOUTH  AND  TEETH 

individual  may  become  unable  to  properly  close 
his  mouth.  He  then  becomes  a  mouth  breather 
instead  of  properly  breathing  through  his  nose, 
with  a  consequent  pale  look,  sickly  feeling,  anemic 
hue  and  unhealthful  condition  in  general,  because, 
instead  of  breathing  correctly  through  the  nose 
where  the  fresh  air  taken  in  is  purified  before  it 
enters  the  lungs,  he  breathes  incorrectly  and  is 
virtually  poisoned  by  having  to  take  into  his  body 
by  way  of  the  mouth  all  those  foreign  substances 
which  otherwise  would  have  been  removed  and 
which  greatly  lower  the  value  of  the  air  he  breathes 
in  and  deprive  the  tissues  of  its  purity. 

Let  us  now  consider  what  happens  when  a  badly 
decayed  tooth,  or  one  in  which  the  pulp  has  been 
reached  by  decay,  is  neglected  in  spite  of  nature's 
warning  of  pain.  After  a  short  time,  especially 
if  a  large  cavity  is  present,  allowing  various  germs 
in  the  mouth  to  enter  into  the  pulp  cavity,  the 
tissues  of  the  pulp  decompose,  due  to  the  action 
of  the  saprophytic  bacteria,  which  live  on  decom- 
posing tissues,  and  which,  with  the  aid  of  other 
harmful  germs  present,  give  rise  to  the  formation 
of  foul  gases  and  poisonous  products,  all  of  which 
may  result  in  what  is  called  an  alveolar  or  dental 
abscess.    We  then  have  a  devitalized  or  dead  tooth 


CARE  OF  THE  MOUTH  AND  TEETH  37 

which  is  accompanied  by  intense  pain  and  swollen 
features.     Not  alone  do  we  have  to  suffer,  but 
our  daily  tasks  are  interfered  with  and  our  health 
undermined.     We  surely  now  seek  proper  treat- 
ment  and    if    fortunate    enough    may    have    the 
affected  tooth  restored  to  a  useful  condition.  How- 
ever, even  if  this  condition  is  cured,  the  tooth, 
having  lost  its  vitality,  is  of  less  value  to  us  than 
if  it  were  healthy,  for  these  reasons:    Firstly,  it 
is  more  easily  decomposed  by  further  decay  or 
broken  up  by  the  force  of  mastication  because  the 
pulp,  when  dead  and  removed,    can    no    longer 
supply  nutrition  to  the  various  internal  tissues  of 
the  tooth  and  hence  its  power  of   resistance  to 
disease   or   resistance   to   crushing   stress   is   lost. 
Secondly,  it  loses  its  crushing  power  in  mastica- 
tion because  the  artificial  substitute  for  its  decayed 
structure,  or  filling,  is  not  as  strong  as  the  original 
tooth  structure  itself.     Thirdly,  its  roots  contain- 
ing perhaps  some  decomposed  pulp   tissue  im- 
possible to  remove,  may  be  the  source  of  future 
trouble.     Fourthly,  it  loses  its  color  and  becomes 
unsightly  or,  if  not  badly  discolored,  never  has  its 
original  natural  appearance. 

On  the  other  hand  not  alone  may  the  tooth 
be  affected  but  sometimes  the  jaw-bone  around  it 


38  CARE  OF  THE  MOUTH  AND  TEETH 

and  even  the  whole  body,  through  the  spreading 
of  the  diseased  condition,  and  then  we  may  have 
blood  poisoning,  which  results  very  seriously. 

Very  often,  however,  a  devitalized  tooth  is  en- 
tirely neglected  and  proper  dental  treatment  not 
sought  for  because  the  tooth  does  not  pain.  In 
such  a  case  we  are  fooling  ourselves,  because  the 
diseased  condition  about  the  root  of  the  tooth  still 
exists,  but  only  in  the  form  of  a  "blind"  abscess, 
which  name  is  given  because  of  the  lack  of  ex- 
ternal signs  to  give  warning  of  its  presence.  It 
would  be  difficult  to  appreciate  how  dangerous 
such  a  condition  is,  and  if  only  to  avoid  this  alone 
it  is  worth  our  while  to  uphold  strictly  the  cleanli- 
ness of  the  oral  cavity.  The  poisonous  germs  and 
their  products  hidden  by  the  gum  and  giving  no 
signs  of  their  presence  in  the  mouth  may  slowly 
enter  into  the  blood  and  lymph  vessels  that  pass 
through  that  particular  area  affected  and,  gaining 
a  foothold,  pass  with  those  fluids  into  other  tissues 
and  organs  where  the  diseased  condition  is  spread. 
This  is  the  greatest  unseen  danger  in  neglecting 
our  teeth,  and  when  our  bodies  are  thus  a  strong- 
hold of  disease  originating  unseen  in  the  mouth, 
we  are  in  a  septic  or  poisonous  condition.  Those 
organs  which  are  not  in  a  strictly  healthful  con- 


CARE  OF  THE   MOUTH   AND  TEETH  39 

dition  and,  as  we  say,  run  down,  are  the  easiest 
to  be  thus  afflicted,  and  are  made  still  worse  by  the 
presence  of  the  germs  and  poisonous  products  com- 
ing by  means  of  the  blood  vessels  from  the  ab- 
scessed roots  of  neglected  teeth.  In  this  way  we 
may  become  victims  of  such  diseases  as  inflamed 
joints,  for  instance,  swollen  wrists  or  ankles;  de- 
formed joints,  in  which  condition  the  bones  lose 
their  proper  functions  and  positions,  resulting,  for 
instance,  in  lameness ;  general  gout,  or  rheumatism; 
kidney  disease,  stomach  disease,  liver  disease,  in- 
testinal diseases,  nervous  diseases,  heart  disease  and 
anemia,  or  lack  of  healthy  blood.  Thus  we  see 
that  our  entire  body  may  be  affected  and  our  health 
demolished  through  the  action  of  an  unknown 
source  of  disease  resulting  from  neglect  and  lack 
of  cleanliness. 

There  is  another  way  in  which  we  may  be- 
come victims  of  bodily  disease  through  a  neglected 
decayed  tooth.  Suppose  a  child  of  ten  years,  in 
a  poor  physical  condition  and  possessing  an  un- 
clean mouth,  has  a  devitalized  first  molar  with 
a  large  cavity  in  it.  Now  it  is  possible  that  some 
disease  germs,  for  instance,  as  is  most  common, 
the  tubercle  bacillus  or  germ  of  tuberculosis,  may 
be  breathed  into  the  mouth  and  find  their  way  into 


40  CARE  OF  THE  MOUTH  AND  TEETH 

the  cavity  of  decay,  into  the  roots,  and  thence  into 
the  blood  or  lymph.  Then  the  child  may  be 
afflicted  with  small  rounded  swellings  about  his 
neck,  which  would  represent  the  desire  upon  the 
part  of  the  body  to  fight  off  the  disease  and  pre- 
vent it  from  going  further.  But  if  the  child  is 
weak  and  in  poor  physical  health  the  barrier  fails 
and  the  germs  get  further  into  the  body,  where 
they  then  in  one  location  or  another  set  up  the 
fateful  disease. 

Let  us  turn  to  still  another  undesired  condi- 
tion caused  by  neglected  care  of  the  teeth.  If 
during  our  early  years  we  do  not  properly  cleanse 
our  teeth  and  do  not  have  them  thoroughly 
cleansed  by  the  dentist  himself,  as  we  shall  later 
mention,  there  arises  upon  the  roots  and  the  crowns 
a  hard  accumulation  called  tartar,  which  is  the 
result  of  the  unremoved  collection  of  hardened 
material  formed  in  such  a  case  by  the  salts  in  the 
saliva  which  clings  to  the  teeth  and  being  undis- 
turbed, remains  there.  Gradually,  sometimes  in 
months  and  sometimes  in  years,  the  tartar  grows 
in  amount,  forcing  the  gum  from  the  root  of  the 
tooth  on  which  it  collects.  There  is  then  deposited 
in  the  space  formed  various ^  micro-organisms 
which  cause  the  formation  of  infectious  matter 


CARE  OF  THE  MOUTH  AND  TEETH  4 1 

and  the  establishment  of  a  disease  called  Riggs' 
disease,  or  pyorrhea  alveolaris.  This  matter  is 
constantly  discharged  into  the  mouth,  where  it 
poisons  the  tissues,  disgusts  the  person  afflicted, 
and  in  all  probability  is  swallowed.  This  then 
results  especially  in  digestive  diseases,  for  instance, 
when  the  germs  thus  swallowed  get  into  the  intes- 
tines, appendicitis.  Besides,  of  course,  the  gums 
gradually  leave  the  roots  of  the  teeth,  the  bony 
support  is  destroyed  and  the  teeth  then  drop  out 
or  are  hopelessly  loosened,  thus  depriving  us  of 
important  structures  both  in  the  preparation  of 
food  for  digestion  and  speech. 

Having  generally  considered  the  evil  results 
of  decayed  teeth  we  will  turn  our  attention  to  the 
mouth  as  a  whole,  for  we  have  said  there  are 
present  constantly  here  germs  of  all  description 
no  matter  how  healthy  the  mouth,  and  these  micro- 
organisms, together  with  the  food  remnants,  dead 
tissue  cells  and  mucous  or  cellular  discharge,  make 
an  ideal  breeding-place  for  disease. 

Therefore  if  no  measure  of  cleanliness  is 
carried  out  to  remove  these  unhealthful  deposits 
as  thoroughly  as  we  can,  the  following  conditions 
may  result: 

Firstly:  The  presence  of  disease  germs  which 


42  CARE  OF  THE  MOUTH  AND  TEETH 

are  allowed  to  grow  freely  may  be  so  numerous 
as  to  result  in  their  being  swallowed,  thus  result- 
ing, if  the  individual  is  run  down,  in  a  general 
disease,  as,  for  instance,  typhoid  fever. 

Secondly:  They  may  cause  an  inflammation 
of  the  gums,  cheeks,  lips,  tongue,  tonsil,  palate 
or  throat  by  their  irritant  action. 

Thirdly:  They  may  act  upon  the  food  par- 
ticles and  cause  their  decomposition,  resulting  in 
the  formation  of  foul  gases  with  a  consequent  bad 
odor  and  taste. 

Fourthly:  They  may  be  swallowed  with  food 
particles,  thus  interfering  with  the  healthy  action 
of  digestive  organs,  consequently  ending  with  im- 
paired nutrition  or  improper  feeding  of  the  body 
cells  and  tissues. 

Fifthly:  Various  coloring  germs  may  become 
imbedded  in  the  enamel  of  the  teeth,  thus  causing 
them  to  take  up  unsightly  stains. 

Sixthly:  At  night,  if  abundantly  present,  the 
zymogenic  micro-organisms  will  produce  a  de- 
cidedly acid  condition,  thus  serving  as  a  helpful 
agent  of  decay,  for  it  is  now  that  the  saliva  loses 
its  alkaline  or  anti-acid  properties  and  is  least  able 
to  fight  ofif  the  lactic  acid  that  is  at  this  time  so 
freely  formed. 


CARE  OF  THE  MOUTH  AND  TEETH  43 

Seventh :  It  is  in  the  oral  cavity  that  the  very 
factors  in  tooth  decay  are  present,  and  unless  al- 
ways on  our  guard,  the  lactic  acid  will  be  formed 
in  alarming  quantity. 

As  it  is  much  easier  to  prevent  all  of  these  con- 
ditions mentioned,  both  in  regards  to  the  teeth  and 
the  rest  of  the  mouth,  than  to  cure  or  relieve  the 
diseased  conditions  when  present,  let  us  see  how 
this  may  be  done  and  how  all  dangerous  sources 
of  ill-health  in  the  oral  cavity  may  be  removed  or 
at  least  lessened,  and  for  this  very  purpose  we 
will    turn    to    discuss  those  measures    which,  if 
honestly  carried  out  every  day  of  our  lives  that 
it  is  possible  to  do  so,  will  greatly  add  to  our  own 
comfort  and  progress  and  consequently  the  im- 
provement of  the  whole  community  in  which  we 
live. 


CHAPTER  V 

MEASURES  OF  ORAL  HYGIENE 

The  first  thing  to  consider  in  studying  the 
measures  or  duties  of  oral  hygiene  is  our  purpose 
in  following  out  these  procedures,  or,  in  other 
words,  to  have  a  full  understanding  of  what  is  to 
be  attained  in  preserving  the  healthful  conditions 
of  the  mouth  and  teeth.  In  the  first  chapter  we 
explained  the  meaning  of  oral  hygiene,  in  the 
second  chapter  we  described  briefly  the  healthful 
working  of  our  bodies  in  general  in  order  to  ap- 
preciate the  relationship  between  the  oral  cavity 
and  the  rest  of  the  body.  We  then  described  the 
uses  and  functions  of  the  structures  in  the  mouth, 
and  in  the  preceding  chapter  we  observed  the  evil 
results  arising  from  neglect  of  the  proper  care  of 
the  entrance  to  our  body.  Thus  we  have  discussed 
the  healthful  and  unhealthful  aspects  without  go- 
ing into  a  too  detailed  or  technical  account.  In 
other  words,  all  that  has  been  said  before  helps 
us  to  understand  the  end  or  purpose  to  be  achieved, 
by  showing  us,  firstly,  in  a  positive  manner,  the 
conditions  to  be  desired  in  health;  and  secondly, 

44 


CARE  OF  THE  MOUTH  AND  TEETH  45 

in  a  negative  manner,  the  conditions  to  be  avoided 
by  strict  attendance  to  the  proper  care  of  the  mouth 
and  teeth;  and  now  we  shall  show  the  means  to 
the  end  by  explaining  the  duties  to  be  carried  out 
in  order  to  attain  our  object. 

The  measures  of  oral  hygiene  may  be  divided 
into  four  groups: 

First:  Local,  or  most  important,  depending  en- 
tirely upon  ourselves. 

Second:   Dietary,  relating  to  the  food  we  eat. 

Third:  General  or  considerations  concerning 
our  bodily  welfare  as  a  whole. 

Fourth:  Unfailing  periodical  examination, 
prophylactic  and  all  other  necessary  treatment  by 
the  dentist. 

All  of  those  measures  proposed  to  prevent  dis- 
ease are  called  prophylactic,  and  those  procedures 
necessary  to  prevent  or  diminish  diseased  condi- 
tions of  the  mouth  and  teeth  are  considered  under 
the  term  of  oral  prophylaxis,  the  most  positive  and 
successful  measure  of  which  is  described  by  one 
word — cleanliness. 

Local  measures :  In  describing  this  part  of  our 
prophylactic  program  we  have  to  consider,  firstly, 
what  must  be  done  in  order  to  obtain  a  constantly 
clean  set  of  teeth,  so  that  the  chief  factors  con- 


46  CARE  OF  THE  MOUTH  AND  TEETH 

cerned  in  producing  decay  of  the  teeth,  namely, 
the  lactic  acid  bacteria  and  their  food,  starchy  and 
sugary  remnants;  and  the  saprophytic  bacteria 
with  their  means  of  subsistence  the  albuminous 
remains  of  the  food  we  consume,  are  thoroughly 
removed  or  at  least  almost  wholly  so.  Secondly, 
we  must  consider  the  constant  use  of  an  antiseptic 
fluid  or  other  form  of  mouth  wash  as  the  individual 
case  requires,  in  order  to  keep  the  various  germs, 
and  other  undesired  substances  which  are  present 
in  the  mouth,  under  at  least  temporary  control. 

Dietary  regulations:  The  relationship  of  our 
food  to  the  progress  of  healthy  teeth  is  an  im- 
portant one.  We  must  give  brief  consideration  to 
the  fact  that  many  foodstuffs  are  the  source  of 
trouble  in  the  oral  cavity  and  we  should  in  a 
few  words  tell  why  we  must  avoid  the  accumula- 
tion therein  of  any  such  food  particles  remaining 
unswallowed. 

General  measures  of  oral  hygiene  bring  into 
consideration  observation  of  those  factors  which 
tend  to  make  the  body  as  a  whole  more  healthy 
and  therefore  help  to  elevate  indirectly  the  health- 
ful condition  of  our  mouth  and  teeth. 

The  absolute  necessity  of  having  the  oral  cavity 
rigidly  supervised  by  our  dentist   is    undisputed 


CARE  OF  THE   MOUTH  AXD  TEETH  47 

and  to-day  forms  a  most  practical  and  beneficial 
measure  of  oral  hygiene. 

We  will  first  consider  the  local  measures  of 
oral  prophylaxis,  starting  with  the  cleansing  of 
the  teeth.     The  most  efficient  agent  at  our  com- 
mand for  this  purpose  is  the  tooth-brush.     A  tooth- 
brush is  an  instrument  used  to  mechanically  brush 
the  teeth,  consisting  of  a  handle  and  cluster  of 
bristles,  so  arranged  as  to  give  the  most  beneficial 
cleansing  action  under  the  conditions  and  purpose 
for  which  it  is  used,  with  the  least  possible  amount 
of  injury  to  the  surrounding  tissues.     The  tooth- 
brush varies  greatly  in  size,  shape  and  material, 
according  to  the  conditions  for  which  it  is  used, 
for  no  particular  kind  is  used  by  everyone,  since 
the  matter  of  choice  Is  best  left  to  our  dentist, 
whose  advice  we  should  seek  in  this  matter.    Some 
are  made  for  mouths  in  accordance  with  the  hard- 
ness or  softness  of  the  gums,  others  for  the  purpose 
of  massaging  the  soft  tissues,  besides  that  of  brush- 
ing the  teeth;  others  for  convenience  in  cleansing 
according  to  the  locality  in  the  mouth  of  the  teeth 
to  be  cleansed;  some  according  to  the  size,  others 
according  to  the  shape  of  the  teeth,  while  others 
upon  the  very  correct  principle  of  conforming  the 
shape  of  the  tufts  of  bristles  to  the  natural  or 


48  CARE  OF  THE  MOUTH  AND  TEETH 

rounded  arrangement  of  the  dental  arch.  The 
handles  are  of  bone,  celluloid,  rubber,  wood  or 
steel,  and  the  bristles  made  so  as  to  be  hard,  medi- 
um or  soft.  While  some  brushes  are  made  in  one 
rigid  piece,  others  have  flexible  handles,  usually 
of  celluloid,  which  are  not  always  as  advantageous 
as  the  former,  because  the  bristles  do  not  hug  the 
teeth  so  thoroughly  in  brushing,  having  a  tendency 
to  spring  away,  due  to  the  free  movement  allowed 
by  the  flexibility  of  the  handle. 

The  next  question  arises  as  to  what  is  used  upon 
the  tooth-brush  to  facilitate  its  action  in  cleansing 
the  teeth.  We  have  at  our  disposal  pastes,  pow- 
ders and  soaps  to  be  used  in  conjunction  with  the 
tooth-brush,  whose  principal  purpose  is  to  assist  the 
latter  by  mechanically  removing  accumulations 
gathered  upon  the  teeth.  It  should  always  be 
borne  in  mind  that  any  substances  in  a  preparation 
for.use  on  the  tooth-brush,  placed  therein  for  other 
purposes  besides  cleansing  action,  as,  for  instance, 
for  antiseptic  use,  are  of  little  value,  because  they 
do  not  remain  long  enough  upon  the  teeth  to  exert 
any  such  influence.     (See  accompanying  plates.) 

Generally  speaking,  these  preparations  should 
not  be  of  gritty  form,  for  in  such  a  case  the  enamel 
would  be  destroyed  by  the  coarseness  of  the  prepa- 


These  photographs  of  various  tooth  brushes  were  obtained  by  permission  o£  The 
Consohdated  Dental  Manufacturing  Company,  New  York,  through  the  courtesy 
of  Dr.  R.  Ottolengui,  Editor  of  Dental  Items  of  Interest,  in  which  Journal  they 
were  originally  published. 


CARE  OF  THE  MOUTH  AND  TEETH  49 

ration  used;  they  should  not  contain  fermentable 
substances  which  might  injure  the  teeth,  and  they 
should  be  free  of  staining  chemicals,  whose  effect 
would  be  to  discolor  the  teeth;  above  all,  they 
should  not  be  actively  acid  in  character. 

The  materials  mostly  used  in  these  preparations 
are  precipitated  chalk,  or  calcium  carbonate,  finely 
ground  magnesium  carbonate  prepared  from  oyster 
shells,  cuttlefish  bone  and  orris  root,  while  ground 
pumice  stone,  borax  and  oxide  of  tin  are  more 
especially  used  by  the  dentist  because  they  are  too 
coarse  for  every-day  use. 

Tooth  powders,  while  usually  white,  may  also 
be  obtained  colored.  Some  powders  may  be  used 
alone,  as,  for  instance,  precipitated  chalk,  while 
others  are  made  consisting  of  more  than  one  in- 
gredient, whose  basis  is  usually  one  of  the  sub- 
stances mentioned  above. 

Pastes  which  are  made  by  the  use  of  glycerine 
or  gelatine  usually  have  precipitated  chalk  as  a 
basis  and  often  contain  soap  in  conjunction  with 
various  other  substances.  While  these  do  not  have 
the  brushing  power  of  powders,  which  are  coarser 
than  pastes,  they  are  usually  pleasant  to  use  and 
practical,  as  they  may  be  distributed  evenly  upon 
the  brush. 


50  CARE  OF  THE  MOUTH  AND  TEETH 

Soaps  consisting  of  various  powders  combined 
with  castile  soap  have  the  advantage  of  removing 
fatty  accumulations  from  the  teeth,  and  if  pure 
and  not  overused,  give  beneficial  results. 

In  this  book  we  purposely  refrain  from  men- 
tioning particular  tooth-brushes  or  cleansing  ma- 
terials, because  this  advice  is  best  given  by  the 
dentist;  but  the  makers  of  these  materials  whose 
preparations  are  recommended  by  the  dentist 
usually  give  their  earnest  efforts  in  perfecting  those 
articles,  so  that  we  may  accept  them  with  security. 

Knowing  now  what  we  have  at  our  command 
to  clean  the  teeth  with  and  assuming  that  we  have 
the  average  healthful  condition  of  mouth  and 
teeth,  let  us  see  how  we  should  use  the  tooth- 
brush so  as  to  obtain  the  most  efficient  results. 

Firstly:  Brush  the  teeth  after  each  meal  if 
possible,  but  especially  before  retiring  at  night 
and  upon  arising  in  the  morning. 

Secondly:  Keep  the  brush  clean  by  rinsing  it 
when  finished  using  and  deposit  it  in  a  clean,  dry 
place,  preferably  within  a  closed  container. 

Thirdly:  Before  applying  the  dentifrice  or 
tooth  preparation,  wet  the  bristles  slightly,  but  no 
more,  or  else  the  bristles  become  soft,  flabby  and 
worse  than  useless.    Apply  the  dentifrice  evenly 


CARE  OF  THE  MOUTH  AND  TEETH  5 1 

over  the  bristles,  so  as  to  assist  in  its  equal  dis- 
tribution to  all  of  the  teeth,  making  one  applica- 
tion for  the  lower  teeth  and  another  for  the  upper. 

Fourthly:  Firmly  grasp  the  handle  and  with 
a  vigorous  wrist  action  brush  all  the  surfaces  of 
all  the  teeth  as  thoroughly  as  possible;  at  the  same 
time  brush  slightly  the  gums  and  soft  tissues  im- 
mediately about  the  roots,  so  as  to  massage  and 
stimulate  them;  but  do  this  with  precaution  or 
else  they  may  be  injured. 

Fifthly:  Never  brush  the  teeth  crosswise,  but 
use  a  circular  motion  whenever  possible.  Brush 
the  lower  teeth  upwards  from  the  gums  to  the 
biting  edges  and  then  carry  the  bristles  over  their 
upper  surfaces,  especially  in  the  region  of  the  bi- 
cuspids and  molars,  where  the  food  remnants  tend 
to  accumulate.  Brush  the  upper  teeth  downwards 
from  gums  to  biting  surfaces,  being  sure  to  cleanse 
also  the  masticating  surfaces  of  these  teeth.  Be 
sure  to  brush  every  surface  of  every  tooth. 

If  we  want  to  be  surest  of  the  correct  way  to 
use  the  tooth-brush,  this  advice  will  be  given  most 
readily  by  our  dentist,  from  whom  we  may  best 
learn  how  to  practically  carry  out  the  fundamental 
principles  we  thus  far  have  outlined. 

The  most  efficient  means  of  removing  any  food 


52  CARE  OF  THE  MOUTH  AND  TEETH 

remnants  between  the  teeth  not  brushed  away  is 
by  the  use  of  dental  floss  silk.  However,  in  using 
this  flossed  silk  we  must  do  so  with  precaution, 
so  as  not  to  injure  any  of  the  soft  tissues.  After 
taking  a  piece  about  six  inches  long,  it  is  firmly 
grasped  with  the  thumb  and  index  fingers  of  each 
hand  in  such  a  manner  as  to  have  these  fingers  of 
one  hand  within  one  inch  of  the  same  fingers  of 
the  other  hand,  so  as  to  firmly  grip  the  floss  silk 
and  prevent  it  from  slipping.  It  is  then  carefully 
passed  between  each  of  the  teeth,  drawing  it 
through  the  spaces  between  them,  starting  from 
the  last  tooth  on  one  side  and  ending  with  the  last 
tooth  on  the  other  side.  This  must  be  done  in  a 
gentle  manner,  as  the  gum  tissue  between  the  teeth 
is  quite  sensitive  and  easily  injured.  This  proce- 
dure after  each  meal  will  greatly  add  to  the  re- 
moval of  all  food  debris  not  already  removed  by 
the  tooth-brush,  and  it  will  at  least  assist  in  cleans- 
ing the  teeth  if  it  is  not  possible  to  use  a  tooth- 
brush. 

Tooth-picks  of  wood  are  best  left  unused,  be- 
cause their  continual  application  injures  the  gums. 
However,  the  occasional  use  of  a  clean  tooth  quill, 
if  carefully  applied,  is  permissible. 

Amongst  local  measures,  the  next  most  impor- 


CARE  OF  THE  MOUTH  AND  TEETH  53 

tant  weapon  of  oral  prophylaxis  is  the  mouth-wash. 
As  this  subject  in  itself  might  give  rise  to  the 
writing  of  a  small  book,  let  us  see  the  importance 
of  the  use  of  a  mouth-wash.     If  we  recollect,  we 
mentioned  previously  the  fact  that  there  are  ever 
present  in  the  mouth  various  germs,  amongst  which 
were  some  whose  activity  in  the  presence  of  un- 
removed  food  particles  gave  rise  to  dental  decay, 
and  others  which  also  were  factors  in  the  progress 
of  that  disease.     In  using  a  mouth-wash  our  chief 
purpose  is  to  counteract  the  growth  and  evil  re- 
sults of  these  micro-organisms,  and  at  the  same 
time  exert  a  general  cleansing  action  upon  all  of 
the  oral  tissues.    These  results  are  brought  about 
by  a  mouth-wash  or  medicated  fluid  which  is  of 
a  neutral  or  alkaline  reaction,  in  the  following 
manner: 

Firstly— It  may  neutralize  any  acidic  condition 
present  in  a  chemical  way,  by  paralyzing  the  acid 
reaction. 

Secondly— It  will  temporarily  hinder  the 
growth  of  these  germs,  and  in  some  cases  destroy 
them. 

Thirdly— It  will  wash  away  any  food  rem- 
nants from  surfaces  of  the  teeth  inaccessible  to  the 
tooth-brush  or  dental  floss. 


54  CARE  OF  THE  MOUTH  AND  TEETH 

Fourthly — It  exerts  a  cleansing  action  upon 
all  of  the  tissue  with  which  it  comes  in  contact  in 
the  oral  cavity,  every  nook  and  corner  of  which 
under  ordinary  circumstances  are  breeding-places 
for  these  hordes  of  invisible  enemies,  many  of 
whom  do  not  sympathize  with  us,  but  are  ever 
ready  to  foist  their  evil  results  upon  our  bodies. 

Fifthly — It  helps  to  remove  unpleasant  tastes 
and  odors  from  the  mouth. 

The  most  efficient  and  satisfactory  mouth-wash 
is  our  own  healthy  alkaline  saliva,  and  happy  in- 
deed would  be  the  one  who  were  fortunate  enough 
to  artificially  duplicate  it  in  composition  and 
action. 

Mouth-washes  may  be  simple,  containing  one 
element,  or  compound  containing  more  than  one, 
most  of  which  latter  are  prepared  for  the  public 
in  practical  and  beneficial  forms.  These  are  called 
antiseptics,  meaning  that  they  tend  to  prohibit 
the  further  growth  of  the  micro-organisms  with 
which  they  come  in  contact,  especially  the  sapro- 
phytic germs. 

Simple  washes,  as  lime-water,  bicarbonate  of 
soda,  or  salt  water,  are  inexpensive  and  often  used 
to  advantage.  However,  the  selection  of  a  mouth- 
wash, like  tooth-brush  and  dentifrice,  should  be 


CARE  OF  THE  MOUTH  AND  TEETH  55 

left  to  the  dentist,  who  can  best  determine  what 
is  the  most  suitable  form  according  to  the  condi- 
tions present  in  the  individual  oral  cavity,  for 
some  mouths  are  dififerent  than  others. 

The  time  to  use  a  mouth-wash  corresponds  with 
that  of  the  tooth-brush,  placing  especial  emphasis 
upon  its  use  on  arising  in  the  morning  and  before 
retiring  at  night,  for  during  the  latter  period  our 
saliva  is  least  resistant  to  the  acid  condition  preva- 
lent at  that  time. 

It  should  be  so  used  that  at  least  half  a  glass- 
ful of  water  must  be  added  to  the  amount  used 
for  each  rinsing,  in  order  to  obtain  the  desired 
action  and  sufficient  volume  of  fluid.  When  taken 
into  the  mouth,  preferably  lukewarm,  the  solution 
should  be  forced,  by  action  of  lip,  cheek  and  throat 
muscles,  into  all  the  crevices  and  surfaces  of  the 
mouth  and  throat,  and  particularly  over  and  be- 
tween the  teeth.  We  should  try  to  gargle  these 
fluids  and  thus  obtain  their  full  benefit,  and  we 
must  always  spend  at  least  one  full  minute  in  using 
such  a  cleansing  fluid. 

A  final  accessory  in  oral  prophylaxis,  regarded 
more  as  a  luxury  than  a  necessity,  is  the  tongue 
scraper,  which,  as  its  name  implies,  is  an  instru- 
ment made  to   remove   accumulations   from   the 


56  CARE  OF  THE  MOUTH  AND  TEETH 

tongue  that  are  often  found  there  upon  arising  in 
the  morning,  or  when  our  digestive  organs  are  not 
in  the  best  of  health. 

Dietary  measures:  It  is  important  for  us  at 
the  present  time  to  understand  some  essential  part 
of  this  interesting  subject.  As  we  may  already 
know  or  may  perhaps  study  later  from  other 
sources,  the  food  we  consume  is  divided  into  several 
groups :  these  are  the  albumins,  or  tissue  builders, 
carbohydrates  and  fats,  or  heat  creators,  inorganic 
salts  and  water.  These  five  foods  are  absolutely 
necessary  to  sustain  life,  and  must  be  in  every 
person's  diet. 

As  far  as  this  discussion  is  concerned,  our  chief 
interest  lies  in  the  carbohydrates  and  albumins  and 
their  relationship  to  the  progress  of  the  mouth  and 
teeth. 

One  great  dietary  mistake  with  us  to-day,  es- 
pecially with  children,  is  the  overuse  of  sugary  and 
starchy  foods  and  delicacies,  as  cakes  and  candies. 
We  previously  referred  to  the  fact  that  such 
substances,  for  instance,  grape-sugar,  cane-sugar, 
fruit-sugar,  starch  and  gum,  are  acted  upon  by  the 
saliva  with  the  formation  of  glucose,  a  simple  form 
of  sugar,  and  we  noted  the  result  of  the  action  of 
the  lactic  acid  bacteria  upon  these  food  remnants 


CARE  OF  THE  MOUTH  AND  TEETH  57 

of  glucose  with  consequent  production  of  decayed 
teeth.  Therefore  we  must  appreciate  this  condi- 
tion and  take  practical  advantage  of  what  it  teaches 
us;  in  other  words,  we  must  restrict  ourselves  in 
the  use  of  such  foods,  and,  above  all,  try  to  sacri- 
fice for  the  sake  of  our  health  at  least  some  of 
these  various  sweets,  which  while  very  tempting 
are  danger  in  disguise. 

The  albuminous  foods,  as,  for  instance,  meat 
and  eggs,  are  also  elements  of  danger  if  not  re- 
moved in  a  thorough  manner,  for  it  is  upon  these 
that  the  saprophytic  bacteria  flourish  and  cause 
their  decomposition  into  foul  gases  which  give  us 
usually  disgusting  taste  and  discomfort,  and  also 
cause  the  origin  of  odors  making  our  presence 
unagreeable,  to  say  the  least,  to  those  about  us. 

One  more  important  point  in  regard  to  our 
food  is  demanded,  and  it  is  this:  we  must  thor- 
oughly chew  every  morsel  which  we  take  into 
our  mouths  and  we  must  exercise  fully  all  those 
functions  which  our  teeth  execute,  not  alone  to 
better  prepare  the  food  for  digestion,  but  by  de- 
veloping the  movements  of  mouth,  jaws  and  teeth, 
to  stimulate  these  tissues  and  aid  in  their  health- 
ful development. 

General   measures:   We   now   come   to   those 


58  CARE  OF  THE  MOUTH  AND  TEETH 

general  prophylactic  considerations  which,  when 
carried  out,  indirectly  assist  the  healthy  oral  cav- 
ity, by  aiding  us  to  maintain  good  constitutional 
physique,  or,  in  other  words,  preserve  the  health 
of  the  whole  body.  While  more  fully  considered 
under  general  hygiene,  we  may,  however,  briefly 
note  that  it  is  to  the  best  of  our  physical  welfare 
to  indulge  in  out-door  exercise  in  pure  air,  secure 
sufficient  rest,  eat  wholesome  food  and  wear  proper 
clothing,  live  in  well-ventilated  rooms  and  assume 
clean  and  good  habits,  all  of  which  are  amongst 
those  necessities  of  good  living,  healthy  bodies  and 
hence  healthier  mouths  and  teeth. 

While  we  must  chiefly  help  ourselves  in  carry- 
ing out  all  these  measures  thus  far  outlined,  it 
evolves  upon  us  as  a  final  duty  in  our  program  of 
oral  hygiene  to  unfailingly  observe  the  following 
statement :  Everyone  of  us  interested  in  the  health 
of  the  mouth  and  teeth  must  visit  a  dentist  at  least 
once  every  six  months  for  the  purpose  of  securing 
all  that  necessary  supervision,  advice  and  treatment 
which  we  are  unable  to  carry  out  ourselves.  For 
no  matter  how  perfect  our  hygienic  efforts,  there 
are  several  measures,  which,  because  of  our  lack 
of  professional  knowledge  and  skill,  we  must  for 
our  own  benefit  have  performed  by  our  dental 


CARE  OF  THE  MOUTH  AND  TEETH  59 

adviser.  The  most  important  of  these  we  will 
now  mention. 

Firstly:  Starting  at  the  age  of  three  years  or 
six  years  at  the  latest,  we  should  secure  the  ad- 
vice of  a  dental  adviser  in  regard  to  the  best  means 
of  preserving  the  health  of  our  mouth  and  teeth. 
Our  dentist  will  then  start  us  on  the  road  to  oral 
health  and  advise  us,  according  to  the  conditions 
he  finds  present,  as  to  the  exact  way  in  which  we 
should  carry  out  our  personal  every-day  prophy- 
lactic treatment.  Furthermore,  even  if  some  of  us 
were  unable  to  have  received  professional  super- 
vision at  such  an  early  age,  we  should  at  our  first 
opportunity  secure  such  advice,  for  it  is  never  too 
late  to  mend.  One  thing  is  certain,  we  must 
never  wait  to  have  pain  before  we  seek  the  dentist, 
for  in  such  a  case  we  will  be  much  worse  off  than 
if  we  had  properly  learned  to  avoid  it,  as  it  will 
always  be  true  that  prevention  is  the  best  cure. 

Secondly :  No  matter  how  thoroughly  we  carry 
out  our  measures  of  personal  oral  cleanliness,  it 
is  an  absolute  necessity  to  periodically  secure  pro- 
fessional prophylactic  treatment;  in  plain  words, 
the  dentist  should  thoroughly  clean  our  teeth  at 
least  twice  a  year.  We  previously  mentioned  that 
there  is  constantly  forming  about  our  teeth  a  sali- 


6o  CARE  OF  THE  MOUTH  AND  TEETH 

vary  deposit  called  tartar,  even  when  in  the  best 
of  health.  Now  although  we  may  thoroughly 
cleanse  our  teeth  each  day,  there  is  sure  to  be  a 
certain  amount  present,  which,  through  our  lack 
of  proper  instruments  and  skill  to  use  them,  has 
not  been  removed,  besides  which,  perhaps,  the  teeth 
may  have  taken  up  a  disagreeable  green  or  yel- 
lowish stain.  Surely  these  deposits  must  be  re- 
moved, for  if  allowed  to  accumulate  the  result  is 
that  sooner  or  later  we  are  victims  of  sore  and 
bleeding  gums,  foul  breath,  disagreeable  taste  and 
loose  teeth,  all  of  which  we  previously  spoke  of 
as  a  disease  termed  pyorrhea.  So  we  must  secure 
this  treatment  every  six  months  by  the  dentist  who, 
with  especially  devised  instruments  and  cleansing 
materials,  is  best  qualified  to  do  that  which  we 
ourselves  cannot  do. 

Thirdly:  The  chief  work  of  the  dentist  is  to 
prevent  disease  of  the  mouth  and  teeth  and  thus 
aid  in  our  general  welfare.  On  the  other  hand, 
where  disease  of  the  mouth  and  teeth  already  exists, 
chiefly  in  the  form  of  dental  decay,  he  stands  ready 
to  check  its  further  progress.  We  explained  be- 
fore that  the  ravages  of  dental  decay,  by  far  the 
most  common  disease  of  mankind,  were  immense, 
how  decay  affected  these  structures  and  how,  when 


CARE  OF  THE  MOUTH  AND  TEETH  6 1 

present,  it  might  lead  to  serious  consequences.  We 
told  how  personal  hygiene  would  help  to  prevent 
such  conditions,  and  now  we  come  to  still  another 
preventative,  namely,  the  supervision  of  our  teeth 
by  the  dentist.  He  alone  is  best  able  to  examine 
them  carefully,  so  that  any  vulnerable  points, 
weakened  tooth  structure,  pits,  defects  or  breaks 
in  the  teeth  may  be  pointed  out  to  us.  And  so 
the  small  areas  of  decay,  unable  to  be  seen  by  us 
because  of  their  hidden  location,  minute  size  or 
failure  to  give  us  pain,  may  be  checked  before  go- 
ing further,  and  by  perhaps  simple  dental  treat- 
ment, save  us  from  those  miseries  which  the  further 
destruction  of  the  teeth  affected  would  result  in, 
if  not  stopped  in  time. 

Dental  decay  usually  destroys  our  teeth  in  such 
a  manner  as  to  make  a  heavy  toll  of  the  very  tooth 
structure  itself,  with  the  formation  of  so-called 
cavities.  This  destruction  may  be  checked  by 
instrumental  and  medical  treatment  of  the  teeth 
affected,  the  chief  object  being  to  remove  the  decay 
already  present  and  prevent  its  deeper  penetra- 
tion, ending  with  the  filling  of  the  cavity  or  other 
form  of  tooth  replacement,  which  restores  the 
original  size,  shape  and  function  of  the  tooth 
affected.     It  is  not  our  purpose  to  study  dentistry 


62  CARE  OF  THE  MOUTH  AND  TEETH 

itself  in  this  little  volume,  but  it  should  be  remem- 
bered that  whenever  treatment  can  be  obtained  for 
the  prevention  and  cure  of  diseased  teeth,  there 
should  be  no  hesitation  upon  our  part  in  carrying 
it  out,  for,  bearing  in  mind  all  the  functions  which 
our  teeth  serve,  we  must  all  agree  that  it  is  best 
to  save  a  tooth  in  time  than  lose  it  when  it  is 
too  late. 

And,  even  if  we  must  sacrifice  some  of  our 
teeth,  we  may  in  some  form  or  other  obtain  artifi- 
cial substitutes  which,  while  far  from  nature's  own 
work,  serve  at  least  some  good  in  restoring  to  us 
a  means  of  mastication,  improved  speech  and 
pleasanter  facial  appearance.  However,  this  is 
another  subject,  for  the  very  object  of  our  dis- 
course is  to  learn  how  to  prevent  such  conditions 
and  not  how  to  cure  them. 

These  words  are  not  written  to  extol  the  den- 
tist, but  surely  his  work  is  important;  for  if  we 
stop  a  moment  to  realize  how  much  good  he  can 
do  us,  we  will  never  hesitate  to  give  him  our  con- 
fidence and  assistance. 

Finally,  let  us  review  briefly  those  measures 
which  we  have  laid  down  in  our  code  of  oral  hy- 
giene in  order  to  impress  them  upon  our  minds. 


CARE  OF  THE  MOUTH  AND  TEETH  63 

Firstly:  Properly  use  a  tooth-brush,  dentifrice, 
dental  floss  and  mouth-wash. 

Secondly:  Eat  few  sweets,  chew  every  par- 
ticle of  food  thoroughly  and  carefully,  remove  any 
food  remnants  remaining  in  the  mouth  or  about 
the  teeth,  after  each  meal. 

Thirdly:  Preserve  the  health  of  the  body  as 
a  whole,  so  as  to  uphold  the  health  of  the  mouth 
and  teeth  in  particular. 

Fourthly:  Visit  the  dentist  at  least  twice  a  year 
in  order  to  secure  all  of  that  advice  and  treatment 
which  we  cannot  administer  to  ourselves. 

Follow  these  rules  carefully  and  there  will 
never  be  cause  for  regret. 


CHAPTER  VI 

BENEFICIAL  RESULTS  OF  ORAL  HYGIENE 

Now  that  we  have  outlined  the  why  and  where- 
fore of  a  healthy  mouth  and  set  of  teeth,  we  can 
fully  appreciate  the  importance  of  our  message  in 
this  little  book,  and  meditate  upon  the  necessity 
of  our  living  up  to  those  measures  which  have 
been  described,  the  unceasing  fulfillment  of  which 
should  be  a  life-long  duty. 

It  has  been  shown  by  those  making  a  study  of 
oral  hygiene  that  over  ninety-five  per  cent,  of 
school  children  are  afflicted  with  dental  decay, 
amongst  other  diseases,  and  if  these  children  alone 
were  made  converts  to  our  cause,  the  benefits  de- 
rived would  be  inestimable.  For  it  has  been  found 
that  those  children,  victims  to  a  large  degree  of 
dental  ailments,  were  backward  in  studies,  sluggish 
in  habits,  of  poor  health,  and  lacked  ambition. 
And  it  has  been  proven  that  these  very  children, 
after  receiving  proper  treatment,  became  better 
scholars,  more  active,  healthier  and  more  ambitious 
than  they  were  previously. 

Amongst  older  folks  the  same  holds  true. 
People  of  various  callings,  workers  of  all  kinds, 

64 


CARE  OF  THE  MOUTH  AND  TEETH  65 

who  have  been  delinquent  in  their  work  because 
of  impoverished  oral  conditions,  have,  after  their 
teeth  were  brought  back  to  healthful  condition  and 
their  mouths  made  clean,  become  of  more  benefit 
to  themselves,  and  of  greater  helo  to  those  about 
them. 

And  so  we  could  go  on  reciting  the  encourag- 
ing changes  thus  brought  about  in  glowing  terms, 
but  suffice  it  to  say  that  the  beneficial  results  of 
oral  hygiene  cannot  be  adequately  explained  by 
any  words  at  our  command. 

For,  after  all,  oral  hygiene  means  many  things  : 
personal  comfort  and  pride  in  our  healthy  mouth 
and  teeth;  a  cleanliness  pleasant  to  ourselves  and 
our   neighbors;    efficient   mastication    and   hence 
proper  digestion  of  our  food;  better  selection  of 
the  foods  we  eat  and  greater  care  in  the  way  we 
eat  them;  ability  to  enunciate  our  words  properly; 
avoidance  of  all  those  ills  of  the  mouth,  teeth  and 
body  in  general  which  cause  so  much  suffering 
and  depression,  improved  health,  cleaner  minds, 
greater  ambition,  stimulation  to  greater  usefulness 
to  ourselves  and  those  about  us ;  these  are  some  of 
the  things  that  oral  hygiene  means,  and  in  these 
ways  it  will  benefit  those  who  desire  to  practice 
it.     Do  you? 


INDEX 


Alveolar  abscess,  36 

process,  14 
Antiseptics,  54 
Apex,  23 
Apparatus,  digestive,  6 

respiratory,  9 
Appendicitis,  41 
Arteries,  7 

Bacteria,  action  of,  29 

action  on  pulp  of,  36 

bacillus  lactis,  28 

food  of,  29 

growth  of,  28 

in  mouth,  28 

in  Riggs'  disease,  40 

saprophytic,  29,  36 
Bicuspids,  17,  25 
Blind  abscess,  38 
Blood  poisoning,  37 
Body,  anatomy  of,  5 

anatomical  groups  of,  6 

cells  of,  5 

food  of,  6 

histology  of,  5 

importance  of  entrance  to,  3 

liquid  waste  of,  10 

means  of  preserving,  1,  3 

nutrition  of,  7 

physiology  of,  5 

solid  waste  of,  7 

tissues  of,  5 
Bronchioles,  10 

Capillaries,  7 
Carbon  dioxide,  8,  10 
Cementum,  18,  19 
Cheeks,  12,  26 
Chewing,  57 


Crown,  18 
Cuspids,  16,  17,  25 

Dental  caries,  30 

prevention  of,  59 
Dental  decay,  28 

cause  of,  29 

complicated  stage  of,  31 

consequences  of,  31,  33 

deep-seated  stage  of,  31 

neglect  of,  31,  33 

prevalence  of,  60,  64 

process  of,  28 

progressive  stage  of,  30 

superficial  stage  of,  30 

treatment  of,  61 
Dental  floss,  51 
Dental  supervision,  45,  58 
Dentifrice,  48 

materials  used,  49 

requirements  of,  48 
Dentine,  19,  20 

Dentist,  importance  of,  4,  11,  30, 
40,  46,  47,  SO,  51,  54,  58,  60,  64 
Devitalized  teeth,  36 

consequences  of,  37 
Dietary  regulations,  46,  56 
Digestion,  33 
Disease,  prevention  of,  2,  4 

caused  by  neglect,  11,  39,  41 

Enamel,  18,  19 

Eruption  of  permanent  teeth,  23 

table  of  permanent  teeth,  24 

temporary  teeth,  22 

table  of  temporary  teeth,  22 

Fauces,  12 

Fillings,  purpose  of,  in  teeth,  61 


67 


INDEX 


68 


Food,  carnivorous,  14 

classes  of,  56 

decomposition  of,  36 

discharge    from    large    intes- 
tines, 7,  10 

herbivorous,  14 

in  blood  vessels,  7 

in  digestive  canal,  6 

omnivorous,  14 

regulations,  56 

retention  in  small  intestines,  6 

waste  in  kidney,  10 

waste  in  lungs,  9,  10 
Function,  permanent  teeth,  24 

temporary  teeth,  26 

General   measures   of   oral   hy- 
giene, 46,  57 
Glucose,  28 
Gums,  18 

Health,  disturbances  of,  Zl 
preservation   of,   by   oral    hy- 
giene, 2 
by  other  means,  3 

Heart,  7 

Incisors,  16,  17,  24 

Jaws,  14 

Kidney,  10 

Lacteals,  8 
Lactic  acid,  28 
Large  intestines,  6 

larjmx,  10 

lips,  6,  12,  26 

liver,  6 
Local  measures  of  oral  hygiene, 

45,  52 
Lungs,  8,  10 

Molars,  16,  17,  25 
Mouth,  care  of,  1 
of  digestive  apparatus,  6 


Mouth  breathing,  Zd 
Mouth  wash,  52 

action  of,  53 

kinds  of,  54 

use  of,  55 
Mucous  membrane  of  digestive 
apparatus,  6 

of  mouth,  12 

Neck,  18 
Nerves,  9 
Nose,  10 

CEsophagus,  6 

Oral  cavity,  2 
boundaries  of,  12 
part  of  digestive  apparatus,  6 
passage  of  blood  through,  8 
relationship  to  body,  1,  8,  10 
relationship  to  respiratory  ap- 
paratus, 10,  11 
structure  of,  12 
supervision  of,  46 

Oral  hygiene,  2 
beneficial  results  of,  64 
consequences  of  neglect  of,  41 
interest  in,  3,  4 
measures  of,  44,  45,  46,  dZ 
necessity  of,  3,  11,  27,  64 
purpose  of,  1,  3,  44 

Oral  prophylaxis,  45,  47,  59 

Oxygen,  8,  10 

Palate,  12,  26 
Pancreas,  6 
Pericementum,  20 
Pharynx,  6,  10 
Prophylactic   regulations,  45 
Ptyalin,  13 
Pulp,  20 

function  of,  21 

structure  of,  20 
Pulp  canal,  19 
Pulp  cavity,  18,  20 
Pulp  chamber,  19 
Pyorrhea  alveolaris,  40,  60 


6o 


INDEX 


Root,  18 
resorption  of,  22 

Saliva,  12 

as  mouth  wash,  54 

contents  of,  13 

functions  of,  13 
Salivary  glands  of  digestive  ap- 
paratus, 6 

of  mouth,  12 
Six-year  molar,   importance  of, 
23,  34 

neglect  of,  32,  34,  36 
Small  intestines,  6 
Speech,  26 
Spleen,  6 
Stomach,  6 
System,  blood  vessel,  7 

relationship  to  lymphatics,  8 

lymphatic,  7 

relationship  to  blood  vessels,  8 

nervous,  9 

Tartar,  40,  59 

Teeth,  anatomical  characteristics, 

19 
arrangement  of,  26 
care  of,  1 
chief  function,  14 
dental  formula  of  permanent, 

17 
dental  formula  of  temporary, 

16 
eruption  of,  21 
functions  of,  IS,  24,  26 


Teeth,   functions  of  permanent, 
15 
functions  of  temporary,  15 
growth  of,  23 
interest  in,  12 

meflibers   of   digestive  appar- 
atus, 6 
members  of  oral  cavity,  14 
most  sensitive  portion  of,  30 
number  of  permanent,  15 
number  of  temporary,  15 
relationship  to  growth  of  sur- 
rounding tissues,  34 
relationship    to    rest    of    the 

body,  11 
tissues  of,  19 
variation  in,  12 
various  kinds  of,  14 

Temporary  teeth,  difference  be- 
tween permanent  and  tem- 
porary, 21 

Third  molar,  24 

Tissue,  inorganic,  19 
organic,  19 

Tongue,  12,  26 

Tongue  scraper,  55 

Tooth  brushes,  47 
use  of,  50 

Tooth  pastes,  48,  49 

Toothpicks,  52 

Tooth  powder,  48,  49 

Tooth  soaps,  48,  50 

Trachea,  10 

Tuberculosis,  39 

Veins,  7 


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